- Benefit
- 2026 caps (for treatment dates Jan 1 - Dec 31, 2026): decile 1 KRW 900,000; deciles 2-3 KRW 1,120,000; deciles 4-5 KRW 1,730,000; deciles 6-7 KRW 3,260,000; decile 8 KRW 4,460,000; decile 9 KRW 5,360,000; decile 10 KRW 8,430,000. For stays of more than 120 days in a long-term care hospital: decile 1 KRW 1,430,000 to decile 10 KRW 10,960,000. Non-covered services, selective benefits and the difference in charges for upper-grade hospital rooms are excluded.
- Who is eligible
- National health insurance members and dependents whose total out-of-pocket copayments for covered services over one year (Jan 1 - Dec 31) exceed their individual cap
- When to apply
- For 2026 treatment, the National Health Insurance Service notifies eligible people and refunds around August 2027
- How to apply
- After receiving the NHIS notice, apply online (nhis.or.kr), by app, at 1577-1000, at a branch, or by fax/mail. Your own bank account is required when applying
- Important notes
- 3-year statute of limitations on refund claims. If you do not apply after the notice, payment is delayed, so check the notice
- Note
- Two methods run in parallel: advance benefit (the hospital bills it when out-of-pocket costs at the same hospital exceed the top cap of KRW 8,430,000) and after-the-fact refund (individual notice around August of the following year). Income decile is based on health insurance premiums.
Based on official sources as of 2026년 10월. Amounts and requirements may change, so please confirm with the official guide before applying.