Medical Care Benefits
Eligibility for Medical Care BenefitsEmployer-sponsored insurance subscribers and their dependents are entitled to the following medical care benefits in the event of illness, injury, and childbirth, etc. (Paragraph 1 of Article 41 of the National Health Insurance Act):
Diagnosis/examination
Drugs and medications
Treatments, including surgery
Prevention/rehabilitation
Hospitalization
Nursing
Transport
※ Scope of Medical Facilities
Medical care benefits (nursing and transport excluded) are provided at the following medical facilities (the former part of Paragraph 1 of Article 42 of the National Health Insurance Act).
A medical institution established in accordance with the Medical Act
A pharmacy registered in accordance with the Pharmaceutical Affairs Act
A distributor of rare/essential Korean drugs registered in accordance with the Pharmaceutical Affairs Act
A health clinic as defined by the Regional Public Health Act
A health clinic established in accordance with the Act on Special Measures for Public Health and Medical Services in Agricultural and Fishing Villages
The Minister of Health and Welfare can exclude from the above-specified range of medical facilities medical institutions or pharmacies determined as inappropriate in view of public interests and national policies, as listed below (the latter part of Paragraph 1 of Article 42 of the National Health Insurance Act and Paragraph 1 of Article 18 of the Enforcement Decree of the National Health Insurance Act):
An auxiliary medical institution established in accordance with the Medical Act
A medical institution established for the purpose of diagnosis of persons admitted into a social welfare facility in accordance with the Social Welfare Service Act
A medical institution suspended from operation as described below for attracting insured persons by not receiving a deductible or receiving a reduced deductible, or for overcharging for medical expenses
√ A medical institution whose operations have been suspended or which has been fined in accordance with the National Health Insurance Act more than two times in five years
√ A medical institution established or operated by a medical professional whose license was suspended in accordance with the Medical Act more than two times in five years
A medical institution or pharmacy established by the founder of a medical facility undergoing suspension or suspended in accordance with the National Health Insurance Act