Eligibility for National Health Insurance Through an Employer
Range of Employer-sponsored Insurance Subscribers
- All workers and employers of a business, public workers, and teachers become employer-sponsored insurance subscribers (the main sentence of Paragraph 2 of Article 6 of the National Health Insurance Act).
- However, individuals who fall under any of the following categories are not eligible for national health insurance through an employer (the proviso of Paragraph 2 of Article 6 of the National Health Insurance Act and Article 9 of the Enforcement Decree of the National Health Insurance Act):
· A day laborer with an employment term of less than one month
· An individual who is in active duty (including corporals who were appointed without applying), who has been transferred in service, or who is a candidate for a military officer's role, in accordance with the Military Service Act
· A public worker in office after being elected in an election, who does not receive monthly wages or a pay equivalent to monthly wages
· Part-time employees including those whose fixed work hours are less than 60 hours per month
· Part-time teachers including those whose fixed work hours are less than 60 hours per month
· Workers and users of a business without a set address
· An employer without employees or with only part-time employees or employees who work less than 60 hours per month
※ Related precedent case: Eligibility of day laborers in employment for over one month for employer-sponsored insurance (Supreme Court ruling 2013Du12461, October 24, 2013)
Considering the purpose of the former National Health Insurance Act (that which was in place before being fully revised to Legislation No. 11141 on December 31, 2011; hereinafter referred to as the "law"), the intent behind its legislation, and its definition of an employer and an employer-sponsored insurance subscriber, a day laborer employed by a construction business that carries out multiple construction works and employs workers at its construction sites, even if he works for a period less than one month at a single construction site, should be considered as an employer-sponsored insurance subscriber in accordance with the law if he continues his employment with the employer by working at its other construction sites over a period longer than one month.
Qualification as an Employer-sponsored Insurance Subscriber
Time of Qualification as an Employer-sponsored Insurance Subscriber
- An employer-sponsored insurance subscriber qualifies for national health insurance on the day he or she begins residence in Korea. However, an individual who falls under any of the following categories shall qualify at the specified time (Paragraph 1 of Article 8 of the National Health Insurance Act):
· Individual who used to receive a medical benefit in accordance with the Medical Care Assistance Act: The day he or she became ineligible for the medical benefit
· Former dependent of an employer-sponsored insurance subscriber (spouse, direct ancestor/descendant, etc.): The day he or she lost status as a dependent
· Individual who used to 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 the "medical aid receivers such as veterans, etc."): The day he or she became ineligible for the medical aid
· Medical aid receivers such as veterans, etc. who applied for health insurance coverage by the insurer: The day he or she made the application
Declaration of Qualification as an employer-sponsored Insurance Subscriber
- Workers and employers of a business, public workers, and teachers who fall under any of the following categories must submit to the National Health Insurance Service (hereinafter referred to as the "Service") a declaration of qualification as an employer-sponsored insurance subscriber within 14 days after the date of qualification (Paragraph 2 of Article 8 of the National Health Insurance Act and the former part of Paragraph 2 of Article 4 and Attached Template No. 6 of the Enforcement Regulations of the National Health Insurance Act):
· Non-employer-sponsored insurance subscriber who becomes an employer-sponsored insurance subscriber by becoming a worker, user, public worker, or teacher
· Worker or user who is an employer-sponsored insurance subscriber who becomes an employer-sponsored insurance subscriber of another employer, or a public worker or teacher who is an employer-sponsored insurance subscriber
· Public worker or teacher who is an employer-sponsored insurance subscriber who becomes a worker, or user who is an employer-sponsored insurance subscriber, or who is transferred to an institution operated under a different head
- If the relationship between an employer-sponsored insurance subscriber and a dependent cannot be verified by a copy of the resident registration, a certificate of family relations register must be provided (the latter part of Paragraph 2 of Article 4 of the Enforcement Regulations of the National Health Insurance Act).
- If the details of a declaration of employer-sponsored insurance made to the Service by a user change, a declaration of change in employer-sponsored insurance must be submitted to the Service within 14 days after such change (Paragraph 5 of Article 4 and Attached Template No. 9 of the Enforcement Regulations of the National Health Insurance Act).