National Health Insurance (Self-Employed Insured)

Issuance of health insurance card

Issuance of health insurance card

- A self-employed insured must submit an application for health insurance certificate to the National Health Insurance Service (hereinafter referred to as the “Service”) to have a health insurance certificate issued (including the documents submitted via the information and communications network under Article 2 (1) 1 of the “Act on Promotion of Information and Communications Network Utilization and Information Protection, Etc.”) and the NHIS must issue a health insurance certificate to the insured or the head of the household of the said insured without delay if requested to issue the certificate ( Article 12 (1) of the “National Health Insurance Act” and Article 5 (1) and (2), attached Forms No. 10, 11, and 11-2 of the “Enforcement Rule of the National Health Insurance Act”).

· The Service may issue a health insurance certificate without any application by the insured if it confirms any acquisition or modification of eligibility to become a self-employed insured with data provided according to Article 96 of the “National Health Insurance Act” (Article 12 (1) of the “National Health Insurance Act” and Article 5 (3) and attached Form No. 11 of the “Enforcement Rule of the National Health Insurance Act”).

· If any details in the health insurance certificate changes, the self-employed insured who has been issued with a health insurance certificate must submit an application for modification to the details of health insurance certificate to the NHIS within 30 days from the date of modification (Article 12 (1) of the “National Health Insurance Act” and Article 5 (4) and attached Form No. 10 of the “Enforcement Rule of the National Health Insurance Act”).

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- If a foreign national becomes eligible to be an insured or a dependent, the NHIS must issue a health insurance certificate to the insured, employer, or the head of the household of the insured without delay (main text of Article 7 (1) of the “Application Standards for Overseas Korean Nationals and Foreign Nationals who Stay in Korea for a Long Period of Time”).

· However, for self-employed insured other than those who are family members of the head of the household with status of stay as permanent (F-5) or marriage to Korean citizen (F-6), the NHIS will issue a health insurance certificate with a validity period of the eligibility as an insured if premiums have been paid (proviso to Article 7 (1) of the “Application Standards for Overseas Korean Nationals and Foreign Nationals who Stay in Korea for a Long Period of Time”).

· If any changes are made to those provided in the health insurance certificate, the insured must submit an application within 30 days from the date on which the cause arose (Article 7 (2) of the “Application Standards for Overseas Korean Nationals and Foreign Nationals who Stay in Korea for a Long Period of Time”).

Submission of health insurance certificate

Submission of health insurance certificate

- When a self-employed insured receives health care benefits, he/she must submit his/her health insurance certificate to a health care institution unless he/she has a compelling cause such as a natural disaster (Article 12 (2) of the “National Health Insurance Act”).

- However, the self-employed insured may not submit his/her health insurance certificate if the health care institution is able to verify his/her eligibility with his/her resident registration card, driver’s license, passport, or any of the following certificates or documents. In this case, if any date of validity is written on the certificate or document, the period must not have been expired (Article 12 (3) of the “National Health Insurance Act” and Article 7 of the “Enforcement Rule of the National Health Insurance Act”):

· A certificate issued by an administrative or public agency that has a photograph attached and contains a resident registration number or a foreign registration number to allow the verification of identity such as a patriot/veteran certificate, disability certificate, alien registration, or any other certificates that verify the identity

· Any documents recorded and managed by an administrative or public agency that has a photograph attached to allow the verification of identity

No improper receipt of health insurance benefits

No improper receipt

- A self-employed insured is prohibited from receiving insurance benefits with documents demonstrating his/her eligibility after he/she loses his/her eligibility (Article 12 (4) of the “National Health Insurance Act”).

- No person is allowed to transfer or lend his/her health insurance certificate or identification card to another person to receive insurance benefits, and no person is allowed to have a health insurance certificate or identification card transferred or lent to him/her or use them for any dishonest purpose to receive insurance benefits (Article 12 (5) and (6) of the “National Health Insurance Act”).

Sanctions against violations

- A person who receives insurance benefits by fraud or by any other improper means or a person who allows another person to receive insurance benefits will be punished by imprisonment with labor for no more than 2 year or by a fine not exceeding 20 million won (Article 115 (4) of the “National Health Insurance Act”).

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