Deductibles
Examples of DeductiblesIn-patient treatment
· The patient will bear 50/100 ofthe expenses of his/her meals [meal expenses during the patient’s hospitalizationperiod (including extra costs spent on additional elements influencing thequality and service of meals provided to the hospitalized patient (hereinafterreferred to as “Additional Meal Expenses”)] added to 20/100 of the totalexpenses of health care benefits (excluding the expenses of meals and dentaltreatment for the disabled as determined and announced by the Minister ofHealth and Welfare) [Article 44(1) of the National Health Insurance Act andArticle 19(1) and subparagraph 1(a)1 of the Attached Table 2 of the Enforcement Decree of theNational Health Insurance Act].
· However, suppose the insuredreceives medical treatment in a hospital ward in the department of psychiatryfor two, three, or four patients, or a hospital ward in a general hospital fortwo, three, or four patients reported by a high-ranking general hospitalaccording to Article 43 of the National Health Insurance Act. In this case, theinsured shall pay 50%, 40%, 30% of the hospital bill, respectively. Or, theinsured may receive medical treatment in a general hospital ward for two orthree patients, or a hospital ward in the department of psychiatry for two orthree patients reported by a general hospital, hospital, oriental medicinehospital, or nursing hospital (limited to nursing hospitals defined as amedical rehabilitation facility under subparagraph 4 ofArticle 58(1) of the Act on Welfare of persons With Disabilities andmeet the qualifications under Article 3-2 of the Medical Service Act) and psychiatric hospitals. In this case, theinsured shall pay 40% or 30% of the hospital bill, respectively, and 10% whenstaying at an isolation hospital ward determined and notified by the Ministerof Health and Welfare (Article 44(1) of theNational Health Insurance Act and Article 19(1) andsubparagraph 1(a)1 of the Attached Table 2 ofthe Enforcement Decree of the National Health Insurance Act).
When treatment at a medical facility or as an outpatient is suitable
Of persons receiving inpatient treatment in a hospital in accordance with the Medical Act, those that fall into the category of patients announced by the Minister of Heath and Welfare as better suited to treatment at a medical facility or as an outpatient shall pay the sum of 40% of the total medical bill and 50% of meal expenses occurring during hospitalization (Paragraph 1 of Article 44 of the National Health Insurance Act and Paragraph 1 of Article 19 and Item A-2 of Subparagraph 1 of Attached Table 2 of the Enforcement Decree of the National Health Insurance Act).
When drugs are prescribed
When drugs prescribed by a doctor or dentist are purchased, the insured shall pay 30% of the total cost (Paragraph 1 of Article 44 of the National Health Insurance Act and Item C-1 of Subparagraph 1 of Attached Table 2 of the Enforcement Decree of the National Health Insurance Act).
√ The deductible to be paid by an insurance subscriber or his/her dependent over the age of 65 when prescribed drugs are purchased is as follows (Item C-1 of Subparagraph 1 of Attached Table 2 of the Enforcement Decree of the National Health Insurance Act and Article 13 and Subparagraph 1 of Attached Table 4 of the Enforcement Regulations of the National Health Insurance Act).
① When the total medical bill does not exceed 10,000 won: 1,000 won
② When the total medical bill exceeds 10,000 won but not 12,000: 20% of the total medical bill
※ Further information on deductibles can be found in the Attached Table 2 of the Enforcement Decree of the National Health Insurance Act and the Standards on Special Cases of Deductibles Calculation.
Q. I wasn't feeling well, so I went to a hospital near me for a diagnosis and they told me to get diagnosed at an advanced general hospital. What is an "advanced general hospital"?
A. An advanced general hospital is a general hospital that meets a certain set of requirements and specializes in advanced treatment of serious illnesses.
An advanced general hospital must include the 20 departments defined in the Regulations on the Designation and Assessment of Advanced General Hospitals and meet the requirements specified in the Medical Act, which stipulate that each department must be equipped with the necessary experts, facilities, and equipment (Paragraph 1 of Article 3-4 of the Medical Act).
Method of PaymentA deductible shall be paid by the person receiving medical care benefits to the medical institution when requested (the former part of Paragraph 2 of Article 19 of the Enforcement Decree of the National Health Insurance Act).
※ What is a Diagnosis-Related Group payment system?
A Diagnosis-Related Group (DRG) payment system groups together inpatients receiving similar treatments and assigns a single price to all of such treatments. Under a DRG payment system, you only incur a medical bill of a preset set amount for the treatment of certain illnesses you are hospitalized for, regardless of the type or quantity of the medical service received.
The DRG payment system is applied to inpatient treatments of cataract surgery, tonsil/adenoid surgery, hemorrhoids surgery, groin/thigh hernia surgery (newborns excluded), appendectomy, uterine/uterine adnexa surgery (malignant tumors excluded), and caesarean delivery.
<National Health Insurance Corporation Website - Policy Center – National Health Insurance - Diagnosis-Related Groups of Medical History>.
Deductibles Excess Coverage by National Health Insurance ServiceIf the total of the deductibles incurred by the insured in a year exceeds the deductibles limit specified in Attached Table 3 of the Enforcement Decree of the National Health Insurance Act, the National Health Insurance Service covers the excess (Paragraph 2 of Article 44 of the National Health Insurance Act and Paragraph 4 of Article 19 of the Enforcement Decree of the National Health Insurance Act).