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Medical Benefit

It is a public assistance system that the nation guarantees the medical problems of low-income citizens who do not have the livelihood maintenance ability or have difficulty living, and it is an important means of national medical security along with health insurance.

It provides medical services (checkup, examination, treatment, etc.) for personal illness, injury, and delivery, etc.

Medical Benefit Recipient

1class recipient

2class recipient

- National Basic Living Security Act Recipient Household incompetent to work, Rare intractable disease severe disease (only a cancer patient, severely burned patient) registrant, facility recipient - Patient without any family or friends (Haengryeo patient) - A person who applies another law Disaster victims, People who got injured or died while trying to save others, adopted children (under 18), persons of national merit, Holder of national intangible cultural heritage, North Korean refugees (North Korean defector), 5.18 democratic activist, the homeless

Households that are not the object of the 1class among the recipients of the national basic livelihood security

A recognized refugee can be the recipient by applying the above criteria.

** Haengryeo Patient as a medical benefit recipient means a person who doesn’t have a fixed abode and is confirmed as a person without family or friends by the police, so the security agency which is cityㆍgunㆍgu office, where haengryeo patient appeared, recognized as a medical benefit recipient by relevant law.

** Haengryeoja who are foreigners and illegal immigrants who also didn’t acquire Korea nationality, cannot be set as a medical benefit recipient. Nationality is acquired by the related statute, and the recipient according to the National Basic Living Security Act has to be arranged first, and after that, you can be arranged as the medical benefit recipient.

** When you are recognized as a medical benefit recipient as the haengyeo patient, continuous treatment is possible without additional process as a medical benefit recipient at the upper medical benefit agency.

Copay

Medical Benefits is a system that the Nation supports the low-income household’s health spending, the principle is to support medical expenses regarding the benefit items listed in [National Health Insurance Care Benefit Standards]. Recipients have to pay part of the total medical expenses personally as the amount below.

Categories	Primary (Clinic)	Secondary (Hospital, General Hospital)	Tertiary (Tertiary General Hospital)	Pharmacy
Type 1 – Inpatient	Not applicable	Not applicable	Not applicable
Type 1 – Outpatient	1,000 KRW	1.500 KRW	2,000 KRW	500 KRW
Type 2 – Inpatient	10%	10%	10%
Type 2 – Outpatient	1,000 KRW	15%	15%	500 KRW

** But, if you use an institution over a general hospital with a mild illness what the Minister of Health and Welfare mentioned, pharmacy copay will be 3% of the pharmacy's total expenses (pay a fixed-rate)

Some recipient has differences in the rate of self-burden amount according to the medical benefit agency and treatment. Check the detailed standard through the link below.

Self-burden exempt and particular items Self-burden ratio

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Inpatient treatment (Health Insurance Review and Assessment Service Medical Benefit Guide Page) https://www.hira.or.kr/dummy.do?pgmid=HIRAA030057020000

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Outpatient care (Health Insurance Review and Assessment Service Medical Benefit Guide Page) https://www.hira.or.kr/dummy.do?pgmid=HIRAA030057020100

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Other (health insurance review page) https://www.hira.or.kr/dummy.do?pgmid=HIRAA030057020200

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Check detailed out-of-pocket expenses per recipient (National Health Insurance Medical Benefits Guide Page) https://www.nhis.or.kr/nhis/policy/wbhada21200m01.do

Copay Indemnification ・ price ceiling

There is a copay indemnification · capping, so when the cost is over the standard below, the Nation will supply the excess cost.

Copay Indemnification Standard	Copay Capping Standard
- 1 class recipient If it exceeds 20,000won for every 30dyas, indemnify 50% of the excess cost - 2 class recipient If it exceeds 200,000won for every 30days, indemnify 50% of the excess cost	- 1 class recipient If it exceeds 50,000won for every 30days, total amount of the excess cost - 2 class recipient If it exceeds 800,000won per year, total amount of the excess cost But, If hospitalized over 240 days at the nursing hospital, 1,200,000won per year. *In case, when applying copay indemnification first, and then copay exceed the certain level (upper limit amount)

Treatment step of the medical benefit

Recipients of the medical benefit, first of all, have to ask out the medical benefit to a primary medical benefit agency, and then able to use in order of a secondary medical benefit agency, a tertiary medical benefit agency.

** If you didn’t follow the procedure of the medical benefit, you are responsible for the entire medical expenses incurred.

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