learn how to get reimbursed for excess hospital expenses under the out-of-pocket maximum. we'll walk you through the details of the National Health Insurance Medical Expense Assistance Program, including who is eligible, how much you'll be reimbursed, and how to apply.
have you ever postponed medical treatment because you were worried about the cost? If you're overwhelmed by the amount of medical expenses you've incurred in a year, you should definitely check out the National Health Insurance Corporation's out-of-pocket maximum. it's a program that reimburses you for medical expenses that exceed a certain amount.
table of contents
- what is the out-of-pocket maximum?
- what's eligible for reimbursement and what's not
- how to apply for reimbursement
- frequently asked questions
- closing thoughts
what is the Out-of-Pocket Maximum?
the out-of-pocket maximum is a medical expense support system that reimburses the excess amount of medical expenses incurred by National Health Insurance enrollees if the total amount of medical expenses incurred in a year exceeds the maximum amount for each individual.
as of 2024, the upper limit will range from 870,000 won to 10,050,000 won depending on your income level. for example, if you incurred medical expenses of 2 million won in a year and the upper limit is 1.5 million won, you can get the excess 500,000 won back.
this program is designed to reduce the burden on families facing financial difficulties due to high medical expenses. It is especially helpful if you are receiving long-term treatment for cancer, serious illness, etc.
what's eligible for reimbursement and what's not
what medical expenses are eligible for reimbursement
health insurance-covered deductibles are eligible for reimbursement. The amount you pay out of pocket for expenses that are covered by your health insurance, such as doctor's visits, hospitalization, surgery, medication, etc.
what's not eligible for reimbursement
unfortunately, the following items are not covered by the out-of-pocket maximum
non-covered items are not covered by health insurance at all and are not eligible for reimbursement. Examples include cosmetic procedures and some herbal treatments.
also excluded are dental implants, hospitalization in a superior double or triple room, chiropractic care, and the purchase of assistive devices.
when you receive your hospital receipt, it's a good idea to check what's reimbursable and what's not.
how to apply for reimbursement
apply online
the most convenient way to apply is online. you can do this by going to the National Health Insurance Service website or through the mobile app TheHealth Insurance.
on the homepage, you can log in with a joint certificate or simple authentication and apply for reimbursement from the Out-of-Pocket Limit menu. the smartphone app is even more convenient, allowing you to apply anytime, anywhere.
apply offline
if you don't have access to a computer or smartphone, you can visit your nearest KHIC office. you can also apply by fax, mail, or phone.
you can apply over the phone through the KHIC Customer Center, where a representative will help guide you through the process.
how to receive automatic refunds
it's very convenient to set up a refund account in advance. when you receive a refund, it will be automatically deposited into your account without you having to request it. you only need to sign up once and you'll receive your refund every year.
file on behalf of a family member
if you're unable to apply on your own, a family member can apply on your behalf. they'll need to provide documents such as a power of attorney, proof of family relationship, and identification. this is especially helpful if you're elderly or hospitalized.
related information
there are many ways to maximize your health insurance benefits. in addition to out-of-pocket maximums, there are a variety of medical expense assistance policies, such as catastrophic medical expense assistance and emergency welfare medical assistance, to help you find the right plan for your situation.
Installing TheHealth Insurance app will help you manage your health by allowing you to see your medical history, health checkup results, and prescription history at a glance.
the website of the National Health Insurance Service provides various services such as insurance premium inquiry, issuance of various certificates, and health information.
frequently asked questions
when will I receive my out-of-pocket maximum reimbursement?
typically, reimbursements are issued the year after the calendar year ends. medical expenses for 2024 will be settled and reimbursed in 2025. however, there is also a semi-annual advance reimbursement system, so if you have high medical expenses in the first half of the year, you may get some reimbursement in the second half.
does it matter if someone in my family has a lot of medical expenses?
no, the out-of-pocket maximum applies to each individual. each family member's medical expenses are calculated separately and reimbursed only if they exceed their respective limits. however, there is a household aggregation exception that allows you to combine your family's medical expenses in some cases.
how is the cap determined?
the cap is divided into 10 bands based on your income level. the lower your income, the lower the cap, and the more reimbursement you can get. you can find out what your cap is on the Health Insurance Portal website or in the app.
i forgot to file for a refund, what can I do?
you can claim your reimbursement for up to five years. you can also file retroactively for medical expenses from past years, so don't wait to file, even if it's too late.
can I get some reimbursement for non-payroll items?
unfortunately, non-covered items are not subject to the out-of-pocket maximum. However, some non-covered items may become covered in the future, so it's a good idea to keep an eye on health insurance policy changes.
closing thoughts
out-of-pocket maximums are an important safety net for people struggling with high medical bills, so if you have a large medical bill, be sure to check it out and get reimbursed.
signing up for a reimbursement account is a great way to get money back automatically. The Health Insurance app is a great way to keep track of your medical expenses and check if you're over the limit.
if you have any more questions about hospital reimbursement, let us know in the comments. If you found this information helpful, please subscribe and like us. we'll keep you updated with more great health tips.