Coinsurance rate for chronic diseases reduced from 30%→20%

When treated at local clinics in Korea

Partial amendment to the ‘Enforcement Decree of the National Health Insurance Act’ passes Cabinet Meeting review

Scheduled to take effect from August 21st

#1 The coinsurance rate for outpatient treatment at neighborhood clinics for chronic diseases such as hypertension and diabetes will be reduced by 10%, from 30% to 20%.

 

The Ministry of Health and Welfare announced on the 13th that a partial amendment to the ‘Enforcement Decree of the National Health Insurance Act’ was approved at a cabinet meeting.

 

The amendment includes the legal ground for a 10% reduction (from 30% to 20%) in the coinsurance rate for outpatient visits to clinics for chronic patients who meet the requirements notified by the Minister of Health and Welfare, such as applying for integrated management services for hypertension and diabetes and establishing and establishing and receiving review for customized management plans.

 

The co-payment reduction system will be implemented from August 21st.

 

The Ministry of Health and Welfare said that the amendment is expected to contribute to improving health by preventing complications, improving the healthcare delivery system, and encouraging rational use of healthcare by encouraging chronically ill patients to receive comprehensive and continuous management at neighborhood clinics.

 

In addition to improving the coinsurance rate system for chronic diseases at the clinic level, the amendment also includes an exemption from reporting the total remuneration to the National Health Insurance Service if users submit a simplified withholding tax statement.

 

Starting with the year-end settlement in 2025 (attributable to 2024), employers will be able to submit a simplified withholding tax statement (earned income) to the tax authorities, which will allow year-end settlement of insurance premiums through data linkage with the National Tax Service without reporting the total remuneration amount to the NHIS, which is expected to reduce the workload of employers.

 

However, users should be aware that if they have not submitted a simplified withholding tax statement to the tax authorities, or if there is an error such as an omission of information on the simplified withholding tax statement, they will need to report the total remuneration amount of the previous year as they currently do.

 

Also, to revitalize the monthly income adjustment system, the government has expanded the number of income brackets eligible for adjustment from 2 to 6 and made it possible to apply for adjustment not only if your income has decreased from the previous year, but also if it has increased.

 

If a subscriber has temporarily earned more income than the previous year, he or she will be charged a higher premium next year, but from January 1, 2025, he or she will have the option to pay the higher premium in the year he or she earned the income through the monthly income adjustment process.

 

The 2024 out-of-pocket maximum for the bottom 30% of the income bracket (income quintiles 1-3) will remain the same as last year to relieve the burden of out-of-pocket costs for medical expenses for lower-income subscribers.

 

Also, to prevent social hospitalization in long-term care hospitals, the out-of-pocket maximum for nursing hospital stays of more than 120 days will be increased by the previous year's consumer price index (3.6%) for all quintiles (1st-10th), including those that fall in the bottom 30% of the income bracket.

 

"The amendments to the Enforcement Decree are a follow-up to the 2nd Comprehensive National Health Insurance Plan announced in February," said Joong-gyu Lee, Director of the Bureau of Health Insurance Policy at the Ministry of Health and Welfare.

 

"By unifying the year-end tax settlement report and expanding the scope of income monthly adjustment applications, these amendments will improve the convenience of insurance premium payments and contribute to easing the burden of medical expenses for chronically ill and low-income subscribers who receive comprehensive care."