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Coverage Details

It refers to the services provided in the form of goods or cash, as mandated by law, for the prevention, diagnosis, treatment, rehabilitation, childbirth, death, and health promotion related to the diseases and injuries of the insured and their dependents.

National Health Insurance Benefits Page(https://www.nhis.or.kr/english/wbheaa02600m01.do)

Insurance Benefits - Goods benefits	- Medical Care Expenses - Health Checkup Benefits
Insurance Benefits - Cash Benefits	- Medical Care Expenses - Assistive Devices for Disabled Individuals - Personal Responsibility Amount Ceiling - Pregnancy/Childbirth Medical Expenses

1. Medical Care Expenses

For inpatient or outpatient treatment, the person who receives medical care benefits is required to pay a portion of the costs in accordance with Article 44 of the National Health Insurance Act.

Coinsurance rate

Sort	Institution	Coinsurance Rate
Inpatient Treatment		20% + meals for 50%
Outpatient Treatment	High-level general Hospital	60%
Outpatient Treatment	General Hospital	50%(Dong Areas) 45%(Eup, -Myeon Areas)
Outpatient Treatment	Pharmacy	30%
Outpatient Treatment	Hospital (Dentistry, Oriental Medicine, Rehabilitation, Mental Health)	40%(Dong Areas) 35%(Eup, -Myeon Areas)
Outpatient Treatment	Clinic (Dentistry, Oriental Medicine, General Clinic) / Health Center	30%

2. Medical support

Self-Payment Ceiling System

In order to alleviate the household burden caused by excessive medical expenses, if the total amount of health insurance contributions paid by patients for one year (1.1 to 12.31) exceeds the following standards, then the Health Insurance Corporation pays the excess amount.

** However, excluding non-benefit, screening benefits, full out-of-pocket expenses, implants, hospitalization fees for upper-level ward (2-3 rooms), Chuna therapy, outpatient first-time and out-of-pocket expenses for mild disease at higher-level general hospitals

There are two types of application methods: pre-payment and post-payment of benefits.

Pre-payment: If the patient's annual amount of co-payment expenses at the same healthcare facility exceed 8.08 million won (as of 2024), the patient covers up to 8.08 million won, and any excess amount is billed to the National Health Insurance by the healthcare facility.

** Exclusion of Pre-payment for Nursing Hospitals since January 1, 2020.

Post-payment: At the end of August the following year, the total annual out-of-pocket expenses incurred by the patient for treatments from various healthcare facilities (including pharmacies) during the current year are tallied. If this surpasses the patient's cost ceiling based on the insurance premium level, the National Health Insurance reimburses the patient for the excess amount.

Maternity Care Benefits

This system, operated through vouchers (National Happiness Cards), enables the payment of medical expenses associated with pregnancy and childbirth, encompassing both covered and non-covered items, without differentiation.

** National Happiness Card: An integrated voucher card that allows you to use various vouchers implemented by the nation as one card

Sort	Content
Recipient	- Pregnant or childbirth (including miscarriage and stillbirth) health insurance policyholder or dependant - Legal representative of infants and toddlers under the age of 2 (limited to cases where a childbirth subscriber or dependant dies without applying for pregnancy and childbirth medical expenses)Mothers under the age of 19 can apply for the government's support for pregnancy and childbirth medical expenses for adolescent mothers simultaneously - Unable to apply for payment of medical expenses for pregnancy or childbirth if you have a childbirth or miscarriage abroad - Medical benefit recipients should contact the relevant community center (city/county/district office)
Amount	- 1 million won for a birth / 1.4 million won for multiple births per pregnancy (additional 200,000 won for delivery vulnerable areas) **A birth : One fetal pregnancy/Multiple birth: Pregnancy of two or more fetuses at the same time (twin, triplet…) - Support for medical expenses for pregnancy and childbirth of adolescent mothers: Within KRW 1.2 million per pregnancy - Contact point: Korea Social Security Information Service Call Center 1566-3232 - Apart from the payment of medical expenses for pregnancy and childbirth by health insurance
Duration	- Start date of use: Date of issuance of voucher (date of point creation) If there is a previously issued national happiness card, vouchers can be used from the date of application (date of point creation) without additional issuance - Date of end of use (Application before childbirth) Two years from the scheduled date of delivery (Application after childbirth) Retroactive application of medical expenses prior to the start date of use for two years from the date of childbirth (miscarriage date, stillbirth date) is not applicable - The balance of subsidies that have not been used during the period of use will automatically be extinguished
Coverage	Payment of out-of-pocket expenses(Benefits and Non-Benefits) for the purchase of drugs and therapeutic materials for pregnant women - Partial out-of-pocket expenses (including non-benefit expenses) for the purchase of prescribed drugs and therapeutic materials for infants under the age of 2 (including non-payment expenses) Application and use of pregnancy and childbirth medical expenses for artificial abortion surgery are not allowed (but permitted if it falls under Article 14 (1) of the Mother and Child Health Act (limit to allow for artificial abortion surgery) - It cannot be used if it is not for medical purposes such as issuing medical certificates - Drugs approved by the Ministry of Food and Drug Safety can be purchased, but non-drugs can be restricted -No use of third parties (family, acquaintances, etc.)
How to use	- When it comes to payment of medical expenses at all nursing institutions (hospitals and clinics) with a pass (National Happiness Card), Enter the approval code of '38' in the installment month column of a device when payment is made (In the case of a device that does not generate a monthly installment column when paying less than 50,000 won, the device needs to be upgraded)

Catastrophic medical expense support project

It is a project to provide some medical expenses to people who are suffering from economic difficulties due to excessive medical expenses for parts that are not covered by health insurance.

** Part of medical expenses: Items that are not supported by the out-of-pocket upper limit (preliminary/selective benefits, hospital admission fees for hospital 2 or 3 rooms, etc.) + Full out-of-pocket expenses + some non-benefit items

3. Health programs

Support for smoking cessation treatment

Support for up to six consultations and purchase of anti-smoking medications or anti-smoking supplements (Nicotin patch, gum, tablets) within 8 to 12 weeks

Clinic-level chronic disease management program

Patients with hypertension and diabetes who use clinics (persons with chronic diseases qualified by doctors) shall be relieved of their own burden of examination fees, and additional services for health support projects shall be provided

Dental benefits

Tartar removal / Dental implants for the elderly / Orthodontics and treatments for congenital maxillary deformities / Dental dentures for the elderly

CEO

Number

Address

Inquiry/Error Correction

Jiwon Choi

878-82-00340

120-833 Myeongmul-gil 76-5, Seodaemun-gu, Seoul, Room 103

refugee_health@freemed.or.kr