ENGLISH

- If a person eligible for benefits falls under any of the following categories, the Service can cease the provision of benefits (Paragraph 1 of Article 53 of the National Health Insurance Act).

- If a person eligible for benefits receives a benefit or payment equivalent to an insurance benefit provided by the Service from the central government or a local government in accordance with other legislation, the Service deducts the value of such benefit or payment received from the benefits owed to that person (Paragraph 2 of Article 53 of the National Health Insurance Act).

- If an employer-sponsored insurance subscriber is in default on the monthly premium payment by more than one month, the Service may not provide benefits to the employer-sponsored insurance subscriber or his/her dependent until the payment amount in default is made. Regardless of the period for which a monthly premium payment is in default, if the total number of payments previously defaulted is less than 6 (payments defaulted on that have since been made are excluded from the total number of previously defaulted payments, and the duration of the defaults is not considered) or the income, assets, etc. of the employer-sponsored insurance subscriber or his/her dependent are below the criteria prescribed in Article 26 of the Enforcement Decree of the National Health Insurance Act, no restriction of benefits will be imposed (Subparagraph 1 of Paragraph 3 of Article 53 and Subparagraph 2 of Paragraph 4 of Article 69 of the National Health Insurance Act and Article 26 of the Enforcement Decree of the National Health Insurance Act).

- If an employer is delinquent in paying the monthly insurance premium for an employee (subscriber) and the delinquency is attributable to the employee, insurance benefits for the subscriber and dependents may be suspended by the Service (Paragraph 4 of Article 53 of the National Health Insurance Act).

- Notwithstanding the above regulation, benefits may be provided if an installment payment of a premium in default is approved by the Service and the approved installment payment is made at least once. However, benefits may be suspended if a person approved to make installment payments defaults payment five times or more (if the number of installment payments approved under Article 53(1) of the National Health Insurance Act is less than five, referring to such number of installment payments) of the installment payments. (Article 53(5) of the National Health Insurance Act).

- A benefit received in a period during which no benefits are provided (hereinafter referred to as the "benefit suspension period") is only valid in the following cases (Paragraph 6 of Article 53 of the National Health Insurance Act).

- A person eligible for benefits who falls under any of the following categories will not receive benefits in the specified period. However, in cases 2. and 3., medical care benefits will be provided in accordance with Article 60 of the National Health Insurance Act (Subparagraph 2 of Article 6(2) and Article 54 of the National Health Insurance Act).