Revised Requirements for Health Insurance for Foreigners and Regulations on Out-of-Pocket Costs for Outpatient Services.

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Changes to Health Insurance Regulations for Foreign Residents in Korea

In accordance with the amendments to the National Health Insurance Act, new regulations have been introduced regarding the eligibility criteria for health insurance dependents for foreigners residing in Korea, as well as measures to mitigate excessive outpatient care. The crux of these changes lies in adjusting the requirements for dependents of foreigners who meet residency criteria and expanding the out-of-pocket costs for excessive outpatient services.

1. Strengthened Eligibility Criteria for Foreign Dependents

For foreign nationals or their family members to acquire dependent status under Korea’s health insurance system, they must meet specific residency periods or conditions. This means they are required to complete necessary procedures such as registering their residence, notifying of their stay, or registering as a foreigner, and submit their applications for eligibility within 90 days. If the requirements are not met at the time of application, they will be able to obtain dependent status starting from the day they fulfill those requirements.

This approach is designed to rigorously verify residency conditions and adjust the timing for recognizing eligibility as a dependent, thereby preventing indiscriminate access to benefits.

Detailed Regulations

  • For newborns: The date of birth will be recognized as the point of eligibility if they are born as a dependent of an employee subscriber.

  • If applications are made within 90 days of registration:

  • If all conditions are met: Eligibility will be granted from the date of registration. However, if they become an employee subscriber afterwards, the status will be recognized from their employment start date.

  • If some conditions are not met: Eligibility will be granted starting from the day the requirements are fulfilled.

  • If applications are made after 90 days:

  • If all conditions are met: Eligibility will be based on the application date. If submitted within 90 days after becoming an employee subscriber, the status will be recognized from the employment start date.

  • If some conditions are not met: The date when the requirements are fulfilled will be regarded as the qualification date.

2. Introduction of Outpatient Visit Limits and Increased Personal Responsibility

In a bid to prevent misuse of healthcare resources, it has been established that should the number of outpatient visits exceed 365 in a year, the individual will be responsible for 90% of the costs beyond that limit. This policy aims to curb excessive outpatient visits.

However, certain groups are exempt from this personal cost-sharing requirement:

  • Children as defined by the Child Welfare Act
  • Pregnant women as defined by the Maternal and Child Health Act
  • Individuals with disabilities, patients with rare diseases, and those with severe illnesses under the Disabled Persons Welfare Act

These amendments are intended to promote more effective management of health insurance eligibility among foreigners, while also encouraging the judicious use of medical resources. Special medical needs for those facing significant burdens due to excessive outpatient treatment may qualify for exemptions under specific notices.

Conclusion

This article reflects the situation at the time of writing, and government policies are subject to change. Additionally, this content serves purely as informational and should not be construed as legal interpretation or advice. For more personalized assistance, you can visit our 1:1 Consultation Board.