Purpose of National Health Insurance
Concept of National Health Insurance
- The “National Health Insurance System” refers to a social system securing nationals to receive necessary medical services. Aimed at reducing excessive medical service fees arising from diseases and injuries, the National Health Insurance Corporation manages and operates collected insurance fees from nationals to provide insurance benefits when a national is in need and allocates risks accordingly (National Health Insurance Corporation Website - Policy Center – National Health Insurance).
Characteristics of National Health Insurance
- Mandatory Registration and Premium Payment
· The national health insurance is mandatory for all nationals to join since only people with high disease risks are likely to join, which obstructs the National Health Insurance System’s purpose of collective risk allocation and solution of risks and medical expenses. Therefore, all people shall join the national health insurance, regardless of their intention, and is obliged to pay insurance fees accordingly (National Health Insurance Corporation Website - Policy Center – National Health Insurance).
- Income-based Premium Calculation
· Private insurances charge fees according to the security scope, level of disease risk, contract content, etc. However, the national health insurance is managed as social insurance, meaning insurance fees are imposed according to each national’s payment capacity, such as income levels, etc. since the insurance aims at lessening burdens of excessive medical fees based on social solidarity (National Health Insurance Corporation Website - Policy Center – National Health Insurance).
- Equality in Coverage
· Private insurance provides a personalized guarantee, depending on the insurance fee level and contract content, whereas the, social national health insurance provides equal insurance benefits under related Act and subordinate statute, regardless of the insurance fee burden level (National Health Insurance Corporation Website - Policy Center – National Health Insurance).
Eligibility for National Health Insurance
Eligibility
- Korean nationals residing in Korea, with the exception of the following, become the users or beneficiaries of national health insurance (hereinafter referred to as the "insured") (Paragraph 1 of Article 5 of the National Health Insurance Act).
· Individuals who receive a medical benefit in accordance with the Medical Care Assistance Act
· Individuals who receive medical aid in accordance with the Act on the Honorable Treatment of Persons of Distinguished Services to Independence or the Act on the Honorable Treatment and Support of Persons, Etc. of Distinguished Service to the State (herein after referred to as "medical aid receivers such as veterans, etc."). However, persons who fall under any of the following categories must register for national health insurance.
√ Medical aid receivers such as veterans, etc. who apply for health insurance coverage by the insurer
√ A health insurance subscriber who upon becoming a medical aid receiver such as a veteran, etc. does not apply for exclusion from health insurance coverage by the insurer
※ What is a beneficiary?
- A beneficiary is any of the following whom is dependent on an employer-sponsored insurance subscriber (Article 5(2) of the National Health Insurance Act).
· Spouse of an employer-sponsored insurance subscriber
· Parent or grandparent of an employer-sponsored insurance subscriber (parent or grandparent of spouse included)
· Son or daughter of an employer-sponsored insurance subscriber (son or daughter of spouse included) or the spouse of said son or daughter
· Sibling of an employer-sponsored insurance subscriber
- An individual seeking to become a beneficiary must meet all of the following requirements (Paragraph 1 of Article 2 of the Enforcement Regulations of the National Health Insurance Act):
· Meets the conditions of dependence described in the Attached Table 1 of the Enforcement Regulations of the National Health Insurance Act
· Meets the conditions of income and property described in the attached Table 1-2 of the Enforcement Regulations of the National Health Insurance Act.