Medical benefits
Eligibility to receive medical benefits- A self-employed insured may receive the following health care benefits for diseases, injuries, childbirths, etc. (Article 41 (1) of the “National Health Insurance Act”):
· Diagnosis and medical examinations
· Supply of medicines and materials for medical treatment
· Treatment, surgery, or other types of medical care
· Prevention and rehabilitation
· Hospitalization
· Nursing
· Transfer
※ Scope of health care institutions
- Medical benefits are provided in the following health care institutions (proviso to Article 42 (1) of the “National Health Insurance Act”):
· Health care institutions established under the “Medical Service Act”
· Pharmacies registered under the “Pharmaceutical Affairs Act”
· The Korea Orphan and Essential Drug Center established under the “Pharmaceutical Affairs Act”
· Public health clinics, public health and health care centers, and branches of public health clinics referred to in the “Regional Public Health Act”
· Public health clinics established under the “Act on Special Measures for Health and Medical Services in Agricultural and Fishing Villages”
- However, the Minister of Health and Welfare may exclude medical institutions, etc. determined to be unfit as health care institutions for the public interest or for national policy reasons and exclude the following medical institutions or drugstores (latter part of Article 42 (1) of the “National Health Insurance Act” and Article 18 (1) of the “Enforcement Decree of the National Health Insurance Act”):
· Affiliated medical institutions established under the “Medical Service Act”
· Medical institutions established for the purpose of medical treatment for inmates of social service facilities under the “Social Welfare Services Act”
· Medical institutions which have been subjected to any of the following business suspension dispositions, etc. due to activities of inducing the insured or his/her dependent by means of not receiving the amount of co-payment or receiving a reduced amount, or performing excessive medical treatments in connection therewith, or demanding unreasonably excessive medical fees:
√ Medical institutions which have been subjected to business suspension or disposition of penalty surcharges twice or more for five years under the “National Health Insurance Act”
√ Medical institutions established and operated by medical persons who have been subjected to a disposition of license suspension twice or more for five years under the “Medical Service Act”
· Medical institutions or drugstores established by the founder of the health care institutions subject to a business suspension or under the process of the procedures for business suspension under the “National Health Insurance Act”