Health insurance
What is the difference between National Health Insurance and private insurance in Korea?
To understand medical costs in Korea, first distinguish the National Health Insurance from private insurance.
The National Health Insurance is a public system operated under Korean law. Foreign residents who meet the applicable conditions may receive coverage as workplace-insured persons, individually enrolled residents or dependants. The National Health Insurance Service says that foreign residents with National Health Insurance eligibility receive the same scope of insured healthcare benefits as Korean nationals.
For treatment covered by the National Health Insurance, the cost is divided between the amount paid by the Service and the patient’s share. A patient may still pay part of the cost of an insured service. Non-benefit treatment, to which National Health Insurance does not apply, is generally paid by the patient. “Non-benefit” does not mean that every such treatment is unnecessary; medical need and cost can differ by treatment.
Private insurance is a contract between an individual and an insurer. Some products, such as medical-expense insurance, reimburse part of medical expenses actually paid, subject to the policy terms. Fixed-benefit products instead pay an agreed amount when a specified diagnosis, operation or hospital stay occurs. The coverages, amounts and conditions depend on the product, endorsements and policy terms purchased.
National Health Insurance contributions and private insurance premiums also have different foundations. National contributions are imposed according to law and eligibility, while private premiums depend on the product, coverage, risk factors and enrollment conditions. National Health Insurance enrollment does not automatically enroll you in private insurance, and having private insurance does not automatically exempt you from National Health Insurance eligibility rules.
Comparison
| National Health Insurance | Private insurance | |
|---|---|---|
| Operation | Public system under Korean law | Contract with an insurer |
| Enrollment | Mandatory or applicable according to eligibility | Application and the insurer’s underwriting |
| Coverage standard | Health-insurance law and benefit rules | Product terms and purchased coverage |
| Cost to the individual | Contributions plus the patient’s share when receiving treatment | Premiums plus possible out-of-pocket amounts and exclusions |
| Non-benefit treatment | Generally outside National Health Insurance | May be partly covered or excluded under the terms |
| Basis for disputes | Public-system rules | Insurance contract and policy terms |
What foreign residents should pay particular attention to
National Health Insurance eligibility for foreign residents can depend on employment, length of stay and residence status. Private insurance eligibility follows the insurer’s individual assessment of the product and applicant. Do not apply the eligibility rules of one system to the other.