Modification of the eligibility as self-employed insured
Reasons for the modification of the eligibility as self-employed insured
- A self-employed insured may have his/her eligibility modified on any of the following days (Article 9 (1) 1, , subparagrahs3, 4, 5, and Article 7, subparagraph 2 of the “National Health Insurance Act”):
· The day on which a self-employed insured becomes an employer of a place of business subject to application, or is employed as a worker, public official, or faculty member (hereinafter referred to as "workers, etc.")
· The day immediately following the end of the employment relationship for workers, etc.
· The day immediately following the date on which grounds for temporary or permanent closure, etc. takes place at the place of business subject to application
· The day on which a self-employed insured moves in to another household
Report of changes in the eligibility as self-employed insured
- If any change occurs to the eligibility as a self-employed insured, the employer and the head of the household of a self-employed insured must report the details of the change to the National Health Insurance Service (hereinafter referred to as the “Service”) within 14 days of change according to the following classification (Article 9 (2) of the “National Health Insurance Act” and Article 4 (1) and (2) of the “Enforcement Rule of the National Health Insurance Act”):
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Reasons for eligibility modification
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Modification reporter
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Documents required
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If a self-employed insured becomes an employer of a place of business subject to application or is employed as a worker, etc.
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Employer of an employee insured
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▪ Certificate of eligibility as an employee insured (attached Form 6 of the “Enforcement Rules of the National Health Insurance Act”) ▪ One copy of the certificate of family relationship register (only if the relationship between the dependent and the relevant employee insured cannot be verified by a copy of the resident registration card)
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If the employment relationship for workers, etc. who are employee insured have been terminated
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Head of the household of a self-employed insured
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▪ A report on the acquisition or modification of the eligibility as self-employed insured (attached Form No. 5 of the “Enforcement Rule of the National Health Insurance Act”) ▪ Proof of insurance reduction or exemption ※ However, if an employer has submitted a report on the loss of eligibility for an employee insured (attached Form No. 8 of the “Enforcement Rules of the National Health Insurance Act”), he/she will be deemed to have submitted a report on the acquisition or modification of the eligibility as self-employed insured.
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If the ground for temporary or permanent closure arises at a place of business subject to application
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The day on which a self-employed insured moved in to another household
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Loss of eligibility as a self-employed insured
When the eligibility as a self-employed insured is lost
- A self-employed insured will lose his/her eligibility on the day he/she falls under any of the following circumstances (Article 10 (1) of the “National Health Insurance Act”):
· The day immediately following the date of his/her death
· The day immediately following the day he/she loses his/her nationality
· The day immediately following the day he/she ceases to reside within the country
· The day he/she becomes a dependent of the employee insured
· The day he/she becomes an eligible recipient of health care benefits under the “Medical Care Assistance Act”
Report of the loss of eligibility as a self-employed insured
- If a person has lost his/her eligibility as a self-employed insured, the head of the household of the relevant self-employed insured must submit a report on the loss of eligibility as a self-employed insured to the NHIS within 14 days of such loss (Article 10 (2) of the “National Health Insurance Act” and Article 4 (4) 1 and attached Form No. 7 of the “Enforcement Rule of the National Health Insurance Act”).
Exclusion of subscription of foreign nationals, etc. residing in Korea
What is the exclusion of subscription of foreign nationals, etc. residing in Korea?
- If an overseas Korean national or a foreign national (hereinafter referred to as the “foreign nationals residing in Korea”) is eligible to medical security equivalent to health care benefits under Article 41 of the “National Health Insurance Act” according to the contract with a foreign insurance or employer, he/she may be excluded from the national health insurance at the application of the employer of a foreign national residing in Korea or the subscriber to national health insurance him/herself (see Article 109 (5) 2 of the “National Health Insurance Act”).
How to apply for the exclusion from the subscription as a self-employed insured
- For a self-employed insured such as a foreign national, etc. residing in Korea to apply for the exclusion from the obligation to subscribe to national health insurance, he/she must submit a report on the loss of eligibility as a self-employed insured accompanied by the documents under the following classification to the National Health Insurance Service (Article 61-4 (1) and (3) of the “Enforcement Rule of the National Health Insurance Act”):
· If a person is eligible to receive health coverage according to the foreign laws and regulations: Documents demonstrating that he/she is eligible to receive health coverage such as a written confirmation on the applicability of foreign laws and regulations and documents stating the intent of a foreign national, etc. residing in Korea not to subscribe to health insurance
· If a person received health coverage according to foreign insurance (limited to insurance subscribed before resident registration, domestic residence report, and alien registration): Documents demonstrating that he/she is eligible to receive health coverage such as an insurance agreement and documents stating the intent of a foreign national, etc. residing in Korea not to subscribe to health insurance
· If a person is eligible to receive health coverage according to the contract with an employer: Documents demonstrating that he/she is eligible to receive health coverage such as an employment agreement, documents demonstrating that an employer has paid medical expenses, and documents stating the intent of a foreign national, etc. residing in Korea not to subscribe to health insurance
When the eligibility is lost and the duration of such loss
- Foreign nationals, etc. residing in Korea who are self-employed insured will lose their eligibility on the day of application for exclusion from subscription (Article 76-2 (2) 2 c. of the “Enforcement Decree of the National Health Insurance Act” and Article 4-2 (1) of the “Application Standards for Overseas Korean Nationals and Foreign Nationals who Stay in Korea for a Long Period of Time”).
· However, if a self-employed insured fails to pay his/her premiums or 14 days have not passed since the day he/she first paid his/her premiums, and if he/she applies for exclusion from subscription within six months from the day on which he/she became a self-employed insured, he/she will lost his/her eligibility on the corresponding day.
- Foreign nationals, etc. residing in Korea who have applied for exclusion from subscription will be excluded from subscription while he/she remains eligible to receive health coverage equivalent to the health care benefits according to foreign laws and regulations, foreign insurance, or an agreement with their employer (Article 61-4 (4) of the “Enforcement Rule of the National Health Insurance Act” and Article 4-2 (2) through (5) of the “Application Standards for Overseas Korean Nationals and Foreign Nationals who Stay in Korea for a Long Period of Time”).
· The period during which subscription is restricted cannot exceed one year each time.
· If a person satisfies the requirements to be excluded from subscription again after the period during which the subscription is restricted elapses, he/she may apply for the exclusion of subscription again.
· If the period during which subscription is excluded comes to an end before one year elapses from the day a person was excluded from subscription and he/she becomes eligible to subscribe as a self-employed insured, he/she must report such fact to the NHIS within 14 days from the day on which the case arose.
· A person who has been excluded from subscription because he/she is entitled to receive medical coverage equivalent to health care benefits under foreign laws and regulations is entitled to obtain the eligibility as a self-employed insured by filing an application to the National Health Insurance Service even during the period he/she is subject to the medical coverage. However, a person who becomes eligible again as a result will be unable to apply for the exclusion from subscription again for the same cause.