{"content_id":"02jezrc3ro","slug":"medical-copayment-cap-refund-2026-arrears-check","locale":"en","schema_type":"HowTo","category":"policy_guide","category_name":"Policy Guide","title":"Out-of-Pocket Cap Refunds 2026: Arrears Deduction Rules","summary":"Check your refund eligibility and application status on the National Health Insurance Service website. Arrears deductions apply when notice of an excess amount is issued on or after October 8, 2026.","sponsorship_disclosure":null,"affiliate_disclosure":null,"commerce_disclosure":null,"author":{"name":"OnBinder Editorial Team","url":"https://onbinder.com/ko/about"},"key_points":["Verify your identity on the National Health Insurance Service website to view your refund details.","Check the year of treatment and the amount eligible for payment for each listed item.","If you have arrears, check when the excess amount notice was issued and review the deduction details.","Check whether payment is automatic. If a separate application is required, submit your bank account details.","Compare the application processing result with the amount actually deposited."],"content_markdown":"If your annual qualifying out-of-pocket payments exceed your individual maximum, you are eligible for a refund of the excess amount. Verify your identity on the Service's website to check. Have your own bank account details ready when applying. Check the notice or contact the Service for the claim deadline. (Verified provision: The right to receive insurance benefits becomes time-barred if not exercised for 3 years. · Source: law.go.kr · Verified 2026-10-08)\n\nThe payment totals are based on the Ministry of Health and Welfare's announcement on August 30, 2026.\n\n## How to Check Refunds for Amounts Above the Out-of-Pocket Maximum\n\nCheck through the refund service on the National Health Insurance Service website. You can log in using simple authentication, a joint certificate, or a financial certificate. A direct link may open the login screen first.\n\n1. Visit the Service's website and log in as an individual.\n2. Under Find Services in Civil Services, find Refund Inquiry and Application.\n3. Check that the item listed is an amount above the out-of-pocket maximum.\n4. Check the treatment year and the amount payable.\n5. For cases requiring an application, submit it with an account in your own name.\n\nThe [Service's Refund Inquiry and Application service](https://www.nhis.or.kr/nhis/minwon/retrieveHwangub.do) requires identity verification. If you have difficulty using the online service, call 1577-1000. To use a family member's account, check the required documents first.\n\n## Application Period and Automatic Payment for Out-of-Pocket Maximum Refunds\n\nThe payment process for treatment received in 2025 began on **August 31, 2026**. The announcement also stated that notices would be sent in stages starting that day. Those who do not open the electronic document will receive a notice by mail.\n\n| Category | What to check | Next step |\n| --- | --- | --- |\n| People with an account registered with payment consent | Registered account and payment status | Check whether payment is automatic |\n| People who must apply separately | Payment application notice | Apply with account details |\n| People who have not received a notice | Inquiry results from the Service | Contact a branch if the results are unclear |\n\nPeople with an account registered with payment consent can receive payment without applying separately. Payments for treatment received in 2025 were announced as scheduled to begin in stages on September 2, 2026. Application channels include the website, app, telephone, fax, mail, and in-person visits.\n\nThe announcement does not specify a single nationwide application deadline. This does not mean there is no claim deadline. Check your notice or contact the Service for your individual claim deadline. (Verified provision: The right to receive insurance benefits becomes time-barred if not exercised for 3 years. · Source: law.go.kr · Verified 2026-10-08) The payment schedule and application channels are based on the [Ministry of Health and Welfare announcement](https://m.korea.kr/briefing/pressReleaseView.do?newsId=156775992\u0026pWise=mSub\u0026pWiseSub=C3).\n\n## Comparing Maximums by Treatment Year\n\nThe 2025 maximum applies to payments received in 2026 for treatment received in 2025. The 2026 maximum applies to treatment received in 2026. Choosing the maximum based on the year you receive payment will change the calculation.\n\n| Treatment year | Cases not involving hospitalization for more than 120 days in a long-term care hospital | Hospitalization for more than 120 days in a long-term care hospital |\n| --- | --- | --- |\n| 2025 | KRW 890,000 to 8,260,000 annually | KRW 1,410,000 to 10,740,000 annually |\n| 2026 | KRW 900,000 to 8,430,000 annually | KRW 1,430,000 to 10,960,000 annually |\n\nThe amounts in the table show the range of maximums across insurance premium brackets. Individual amounts are determined based on health insurance premiums and other factors for the treatment year. Do not determine your bracket based only on your current monthly salary. Detailed brackets are available in the [Service's guide to the out-of-pocket maximum system](https://www.nhis.or.kr/nhis/minwon/wbhapa01000m01.do?articleNo=10946900\u0026mode=view).\n\nDependents, as well as insured members, may be eligible for payment. The annual calculation period runs from January 1 to December 31. Qualifying out-of-pocket payments made at multiple hospitals, clinics, and pharmacies are added together.\n\n## Why the Refund Differs from the Total on Your Medical Bills\n\nNot all money paid to a hospital is included in the out-of-pocket maximum calculation. Some items are excluded even when treatment is covered by health insurance. Simply subtracting the maximum from the total on your receipts can overestimate your refund.\n\n- Non-covered services, selectively covered services, and amounts paid entirely by the patient are excluded.\n- Implants and hospitalization charges for 2- or 3-person rooms are also excluded.\n- Patient copayments for Chuna therapy are also excluded.\n- Medical expense assistance from the national or local governments is accounted for through adjustments in the calculation.\n\nOther treatment items are excluded in addition to those listed above. For details, see the [Service's system guide](https://www.nhis.or.kr/static/html/wbma/c/wbmac0209.html). Check the Service's calculation breakdown to determine whether individual medical expenses qualify.\n\n| Payment method | How it works | What to watch for when checking your refund |\n| --- | --- | --- |\n| Advance benefits | The same medical institution bills the Service directly for amounts above the threshold | Check amounts already processed by the hospital |\n| Retrospective refund | Annual qualifying out-of-pocket payments are added together and paid to the individual | Do not count amounts already processed as advance benefits twice |\n\nA total of 2,262,605 people are eligible for payments for treatment received in 2025. The total payment amount was announced as KRW 3,076,000,000,000. This total does not represent the amount scheduled to be deposited into any individual's account. The figures are based on the [summary of the Ministry of Health and Welfare announcement published by KDI](https://eiec.kdi.re.kr/policy/materialView.do?num=286003\u0026pg=\u0026pp=20\u0026topic=L).\n\n## Conditions for Deducting Arrears by Notification Date\n\nDeductions for arrears apply starting with **amounts notified on or after October 8, 2026**. The amended law allows payment after deducting overdue insurance premiums and other amounts owed. Do not determine whether a deduction applies based only on the deposit date.\n\n\u003e This shall apply beginning with cases in which notice of the excess amount is given under the latter part of paragraph 2 of the same Article on or after this Act takes effect.\n\nThis is the wording of Article 2 of the Addenda to the Act Partially Amending the National Health Insurance Act. You can check the application provision in the [enactment and amendment text at the National Law Information Center](https://www.law.go.kr/LSW/lsRvsDocListP.do;jsessionid=fxAr1BU-L1itlxJf6sFuECxM.LSW2?chrClsCd=010102\u0026lsId=001971). Deductions cover insurance premiums and amounts collected under the law that the person concerned is required to pay.\n\n| Situation | What to check |\n| --- | --- |\n| Notice received before the effective date, with payment deposited after it | The deposit date alone does not establish that the new deduction rules apply |\n| Notice of the excess amount received on or after the effective date | Check for arrears and the deduction amount stated by the Service |\n| Notification date is unclear | Ask the Service to check the notification history for the case |\n\nIf a deduction applies, the remaining balance is the amount payable minus the deduction. If the deduction equals the entire amount payable, there may be no deposit. Do not interpret the existence of arrears as meaning you are not eligible for a refund at all.\n\n## What to Check When the Estimated Amount and Deposit Differ\n\nCheck calculation differences separately from deductions made at the payment stage. The first concerns which medical expenses qualified. The second concerns what was deducted from the calculated amount.\n\n1. Check that the treatment year on your receipts matches the refund case you looked up.\n2. Check excluded medical expenses and how medical expense assistance was reflected.\n3. Check the maximum applied and any amounts processed as advance benefits.\n4. Check when you were notified of the excess amount and how much was deducted for arrears.\n5. Compare the Service's final payment details with the deposit record in your bank account.\n\nWhen making an inquiry, specify which items differ. For example, distinguish between a difference in the calculated amount and a difference only in the deposited amount. This distinction reduces how much you need to recheck from the receipts onward.\n\n## Documents for Family Accounts and Applications by a Representative\n\nDocuments required for a family member's account vary by relationship and amount. Ask separately about payment into a family member's account and applying on someone else's behalf. The Service's guidance defines family members as spouses, parents, children, grandchildren, and grandparents.\n\n| Application situation | Main documents to check |\n| --- | --- |\n| Family member's account, at most KRW 300,000 | Payment application form, family relationship certificate |\n| Family member's account, more than KRW 300,000 | Payment application form, power of attorney, detailed family relationship certificate, copies of both parties' identification |\n| Application using a family member's account due to dementia, unconsciousness, or similar circumstances, more than KRW 300,000 | Payment application form, medical certificate or doctor's opinion, detailed family relationship certificate, copy of the account holder's identification |\n\nThe detailed family relationship certificate must have been issued within 3 months before the application date. The medical certificate or doctor's opinion must have been issued within 6 months before the application date. For siblings and others, check the separate rules for third-party accounts.\n\nDocument requirements follow the [Service's guide to required documents by application type](https://www.nhis.or.kr/nhis/minwon/wbhapa01000m01.do?articleNo=10946900\u0026mode=view). Powers of attorney and other forms are available in the [collection of retrospective refund application forms](https://www.nhis.or.kr/nhis/minwon/wbhaba03900m01.do?article.offset=0\u0026articleLimit=10\u0026articleNo=11001385\u0026mode=view\u0026srSearchVal=%EC%83%81%ED%95%9C%EC%A0%9C). Before submitting, check with your local branch about submission methods and any additional documents.","content_html":"\u003cp\u003eIf your annual qualifying out-of-pocket payments exceed your individual maximum, you are eligible for a refund of the excess amount. Verify your identity on the Service's website to check. Have your own bank account details ready when applying. Check the notice or contact the Service for the claim deadline. (Verified provision: The right to receive insurance benefits becomes time-barred if not exercised for 3 years. · Source: law.go.kr · Verified 2026-10-08)\u003c/p\u003e\n\u003cp\u003eThe payment totals are based on the Ministry of Health and Welfare's announcement on August 30, 2026.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#how-to-check-refunds-for-amounts-above-the-out-of-pocket-maximum\" class=\"anchor\" id=\"how-to-check-refunds-for-amounts-above-the-out-of-pocket-maximum\"\u003e\u003c/a\u003eHow to Check Refunds for Amounts Above the Out-of-Pocket Maximum\u003c/h2\u003e\n\u003cp\u003eCheck through the refund service on the National Health Insurance Service website. You can log in using simple authentication, a joint certificate, or a financial certificate. A direct link may open the login screen first.\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eVisit the Service's website and log in as an individual.\u003c/li\u003e\n\u003cli\u003eUnder Find Services in Civil Services, find Refund Inquiry and Application.\u003c/li\u003e\n\u003cli\u003eCheck that the item listed is an amount above the out-of-pocket maximum.\u003c/li\u003e\n\u003cli\u003eCheck the treatment year and the amount payable.\u003c/li\u003e\n\u003cli\u003eFor cases requiring an application, submit it with an account in your own name.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eThe \u003ca href=\"https://www.nhis.or.kr/nhis/minwon/retrieveHwangub.do\"\u003eService's Refund Inquiry and Application service\u003c/a\u003e requires identity verification. If you have difficulty using the online service, call 1577-1000. To use a family member's account, check the required documents first.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#application-period-and-automatic-payment-for-out-of-pocket-maximum-refunds\" class=\"anchor\" id=\"application-period-and-automatic-payment-for-out-of-pocket-maximum-refunds\"\u003e\u003c/a\u003eApplication Period and Automatic Payment for Out-of-Pocket Maximum Refunds\u003c/h2\u003e\n\u003cp\u003eThe payment process for treatment received in 2025 began on \u003cstrong\u003eAugust 31, 2026\u003c/strong\u003e. The announcement also stated that notices would be sent in stages starting that day. Those who do not open the electronic document will receive a notice by mail.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eCategory\u003c/th\u003e\n\u003cth\u003eWhat to check\u003c/th\u003e\n\u003cth\u003eNext step\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003ePeople with an account registered with payment consent\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eRegistered account and payment status\u003c/td\u003e\n\u003ctd data-label=\"Next step\"\u003eCheck whether payment is automatic\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003ePeople who must apply separately\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003ePayment application notice\u003c/td\u003e\n\u003ctd data-label=\"Next step\"\u003eApply with account details\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003ePeople who have not received a notice\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eInquiry results from the Service\u003c/td\u003e\n\u003ctd data-label=\"Next step\"\u003eContact a branch if the results are unclear\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003ePeople with an account registered with payment consent can receive payment without applying separately. Payments for treatment received in 2025 were announced as scheduled to begin in stages on September 2, 2026. Application channels include the website, app, telephone, fax, mail, and in-person visits.\u003c/p\u003e\n\u003cp\u003eThe announcement does not specify a single nationwide application deadline. This does not mean there is no claim deadline. Check your notice or contact the Service for your individual claim deadline. (Verified provision: The right to receive insurance benefits becomes time-barred if not exercised for 3 years. · Source: law.go.kr · Verified 2026-10-08) The payment schedule and application channels are based on the \u003ca href=\"https://m.korea.kr/briefing/pressReleaseView.do?newsId=156775992\u0026amp;pWise=mSub\u0026amp;pWiseSub=C3\"\u003eMinistry of Health and Welfare announcement\u003c/a\u003e.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#comparing-maximums-by-treatment-year\" class=\"anchor\" id=\"comparing-maximums-by-treatment-year\"\u003e\u003c/a\u003eComparing Maximums by Treatment Year\u003c/h2\u003e\n\u003cp\u003eThe 2025 maximum applies to payments received in 2026 for treatment received in 2025. The 2026 maximum applies to treatment received in 2026. Choosing the maximum based on the year you receive payment will change the calculation.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eTreatment year\u003c/th\u003e\n\u003cth\u003eCases not involving hospitalization for more than 120 days in a long-term care hospital\u003c/th\u003e\n\u003cth\u003eHospitalization for more than 120 days in a long-term care hospital\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Treatment year\"\u003e2025\u003c/td\u003e\n\u003ctd data-label=\"Cases not involving hospitalization for more than 120 days in a long-term care hospital\"\u003eKRW 890,000 to 8,260,000 annually\u003c/td\u003e\n\u003ctd data-label=\"Hospitalization for more than 120 days in a long-term care hospital\"\u003eKRW 1,410,000 to 10,740,000 annually\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Treatment year\"\u003e2026\u003c/td\u003e\n\u003ctd data-label=\"Cases not involving hospitalization for more than 120 days in a long-term care hospital\"\u003eKRW 900,000 to 8,430,000 annually\u003c/td\u003e\n\u003ctd data-label=\"Hospitalization for more than 120 days in a long-term care hospital\"\u003eKRW 1,430,000 to 10,960,000 annually\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe amounts in the table show the range of maximums across insurance premium brackets. Individual amounts are determined based on health insurance premiums and other factors for the treatment year. Do not determine your bracket based only on your current monthly salary. Detailed brackets are available in the \u003ca href=\"https://www.nhis.or.kr/nhis/minwon/wbhapa01000m01.do?articleNo=10946900\u0026amp;mode=view\"\u003eService's guide to the out-of-pocket maximum system\u003c/a\u003e.\u003c/p\u003e\n\u003cp\u003eDependents, as well as insured members, may be eligible for payment. The annual calculation period runs from January 1 to December 31. Qualifying out-of-pocket payments made at multiple hospitals, clinics, and pharmacies are added together.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#why-the-refund-differs-from-the-total-on-your-medical-bills\" class=\"anchor\" id=\"why-the-refund-differs-from-the-total-on-your-medical-bills\"\u003e\u003c/a\u003eWhy the Refund Differs from the Total on Your Medical Bills\u003c/h2\u003e\n\u003cp\u003eNot all money paid to a hospital is included in the out-of-pocket maximum calculation. Some items are excluded even when treatment is covered by health insurance. Simply subtracting the maximum from the total on your receipts can overestimate your refund.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eNon-covered services, selectively covered services, and amounts paid entirely by the patient are excluded.\u003c/li\u003e\n\u003cli\u003eImplants and hospitalization charges for 2- or 3-person rooms are also excluded.\u003c/li\u003e\n\u003cli\u003ePatient copayments for Chuna therapy are also excluded.\u003c/li\u003e\n\u003cli\u003eMedical expense assistance from the national or local governments is accounted for through adjustments in the calculation.\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eOther treatment items are excluded in addition to those listed above. For details, see the \u003ca href=\"https://www.nhis.or.kr/static/html/wbma/c/wbmac0209.html\"\u003eService's system guide\u003c/a\u003e. Check the Service's calculation breakdown to determine whether individual medical expenses qualify.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003ePayment method\u003c/th\u003e\n\u003cth\u003eHow it works\u003c/th\u003e\n\u003cth\u003eWhat to watch for when checking your refund\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Payment method\"\u003eAdvance benefits\u003c/td\u003e\n\u003ctd data-label=\"How it works\"\u003eThe same medical institution bills the Service directly for amounts above the threshold\u003c/td\u003e\n\u003ctd data-label=\"What to watch for when checking your refund\"\u003eCheck amounts already processed by the hospital\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Payment method\"\u003eRetrospective refund\u003c/td\u003e\n\u003ctd data-label=\"How it works\"\u003eAnnual qualifying out-of-pocket payments are added together and paid to the individual\u003c/td\u003e\n\u003ctd data-label=\"What to watch for when checking your refund\"\u003eDo not count amounts already processed as advance benefits twice\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eA total of 2,262,605 people are eligible for payments for treatment received in 2025. The total payment amount was announced as KRW 3,076,000,000,000. This total does not represent the amount scheduled to be deposited into any individual's account. The figures are based on the \u003ca href=\"https://eiec.kdi.re.kr/policy/materialView.do?num=286003\u0026amp;pg=\u0026amp;pp=20\u0026amp;topic=L\"\u003esummary of the Ministry of Health and Welfare announcement published by KDI\u003c/a\u003e.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#conditions-for-deducting-arrears-by-notification-date\" class=\"anchor\" id=\"conditions-for-deducting-arrears-by-notification-date\"\u003e\u003c/a\u003eConditions for Deducting Arrears by Notification Date\u003c/h2\u003e\n\u003cp\u003eDeductions for arrears apply starting with \u003cstrong\u003eamounts notified on or after October 8, 2026\u003c/strong\u003e. The amended law allows payment after deducting overdue insurance premiums and other amounts owed. Do not determine whether a deduction applies based only on the deposit date.\u003c/p\u003e\n\u003cblockquote\u003e\n\u003cp\u003eThis shall apply beginning with cases in which notice of the excess amount is given under the latter part of paragraph 2 of the same Article on or after this Act takes effect.\u003c/p\u003e\n\u003c/blockquote\u003e\n\u003cp\u003eThis is the wording of Article 2 of the Addenda to the Act Partially Amending the National Health Insurance Act. You can check the application provision in the \u003ca href=\"https://www.law.go.kr/LSW/lsRvsDocListP.do;jsessionid=fxAr1BU-L1itlxJf6sFuECxM.LSW2?chrClsCd=010102\u0026amp;lsId=001971\"\u003eenactment and amendment text at the National Law Information Center\u003c/a\u003e. Deductions cover insurance premiums and amounts collected under the law that the person concerned is required to pay.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eSituation\u003c/th\u003e\n\u003cth\u003eWhat to check\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eNotice received before the effective date, with payment deposited after it\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eThe deposit date alone does not establish that the new deduction rules apply\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eNotice of the excess amount received on or after the effective date\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eCheck for arrears and the deduction amount stated by the Service\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eNotification date is unclear\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eAsk the Service to check the notification history for the case\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eIf a deduction applies, the remaining balance is the amount payable minus the deduction. If the deduction equals the entire amount payable, there may be no deposit. Do not interpret the existence of arrears as meaning you are not eligible for a refund at all.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#what-to-check-when-the-estimated-amount-and-deposit-differ\" class=\"anchor\" id=\"what-to-check-when-the-estimated-amount-and-deposit-differ\"\u003e\u003c/a\u003eWhat to Check When the Estimated Amount and Deposit Differ\u003c/h2\u003e\n\u003cp\u003eCheck calculation differences separately from deductions made at the payment stage. The first concerns which medical expenses qualified. The second concerns what was deducted from the calculated amount.\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eCheck that the treatment year on your receipts matches the refund case you looked up.\u003c/li\u003e\n\u003cli\u003eCheck excluded medical expenses and how medical expense assistance was reflected.\u003c/li\u003e\n\u003cli\u003eCheck the maximum applied and any amounts processed as advance benefits.\u003c/li\u003e\n\u003cli\u003eCheck when you were notified of the excess amount and how much was deducted for arrears.\u003c/li\u003e\n\u003cli\u003eCompare the Service's final payment details with the deposit record in your bank account.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eWhen making an inquiry, specify which items differ. For example, distinguish between a difference in the calculated amount and a difference only in the deposited amount. This distinction reduces how much you need to recheck from the receipts onward.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#documents-for-family-accounts-and-applications-by-a-representative\" class=\"anchor\" id=\"documents-for-family-accounts-and-applications-by-a-representative\"\u003e\u003c/a\u003eDocuments for Family Accounts and Applications by a Representative\u003c/h2\u003e\n\u003cp\u003eDocuments required for a family member's account vary by relationship and amount. Ask separately about payment into a family member's account and applying on someone else's behalf. The Service's guidance defines family members as spouses, parents, children, grandchildren, and grandparents.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eApplication situation\u003c/th\u003e\n\u003cth\u003eMain documents to check\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Application situation\"\u003eFamily member's account, at most KRW 300,000\u003c/td\u003e\n\u003ctd data-label=\"Main documents to check\"\u003ePayment application form, family relationship certificate\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Application situation\"\u003eFamily member's account, more than KRW 300,000\u003c/td\u003e\n\u003ctd data-label=\"Main documents to check\"\u003ePayment application form, power of attorney, detailed family relationship certificate, copies of both parties' identification\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Application situation\"\u003eApplication using a family member's account due to dementia, unconsciousness, or similar circumstances, more than KRW 300,000\u003c/td\u003e\n\u003ctd data-label=\"Main documents to check\"\u003ePayment application form, medical certificate or doctor's opinion, detailed family relationship certificate, copy of the account holder's identification\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eThe detailed family relationship certificate must have been issued within 3 months before the application date. The medical certificate or doctor's opinion must have been issued within 6 months before the application date. For siblings and others, check the separate rules for third-party accounts.\u003c/p\u003e\n\u003cp\u003eDocument requirements follow the \u003ca href=\"https://www.nhis.or.kr/nhis/minwon/wbhapa01000m01.do?articleNo=10946900\u0026amp;mode=view\"\u003eService's guide to required documents by application type\u003c/a\u003e. Powers of attorney and other forms are available in the \u003ca href=\"https://www.nhis.or.kr/nhis/minwon/wbhaba03900m01.do?article.offset=0\u0026amp;articleLimit=10\u0026amp;articleNo=11001385\u0026amp;mode=view\u0026amp;srSearchVal=%EC%83%81%ED%95%9C%EC%A0%9C\"\u003ecollection of retrospective refund application forms\u003c/a\u003e. Before submitting, check with your local branch about submission methods and any additional documents.\u003c/p\u003e\n","tags":["Health insurance","Everyday Finance","health insurance premium","National Health Insurance Service"],"faqs":[{"question":"Which year's cap applies to refunds received in 2026?","answer":"For care received in 2025, the 2025 cap applies. Check the year of care for the record you looked up before checking the payment year."},{"question":"If I have registered an account for automatic payments, do I need to apply again?","answer":"Those eligible for automatic payment to their registered accounts do not need to apply separately. Check your registered account and payment status."},{"question":"Does having overdue payments mean I cannot receive any refund?","answer":"You can receive a payment if there is a balance remaining after deductions. If the full amount is deducted, there may be no actual deposit."},{"question":"Are overdue amounts deducted from all payments deposited on or after October 8?","answer":"You cannot determine this from the deposit date alone. The supplementary provisions of the amended law state that it applies to cases where notice of the excess amount is given on or after October 8, 2026."},{"question":"Are non-covered hospital expenses included when calculating the cap?","answer":"Non-covered expenses are not included. Selective benefits and amounts that patients must pay in full are also excluded."},{"question":"When is the application deadline?","answer":"The announcement of payments for care received in 2025 did not specify a single application deadline. Check your payment notice or contact the insurance service to confirm your individual claim deadline."},{"question":"What should I do if I have difficulty applying online?","answer":"Contact the insurance service's customer center at 1577-1000 or your local branch. You can apply by phone, fax, mail, or in person."},{"question":"Does not receiving a notice mean I am not eligible?","answer":"Do not assume you are ineligible just because you did not receive a notice. Check through the official service, and contact the insurance service if the result is unclear."}],"sources":[{"url":"https://www.nhis.or.kr/nhis/minwon/retrieveHwangub.do","title":"National Health Insurance Service refund lookup and application","type":"source"},{"url":"https://www.nhis.or.kr/nhis/minwon/wbhapa01000m01.do?articleNo=10946900\u0026mode=view","title":"National Health Insurance Service out-of-pocket maximum system: Annual caps and required documents","type":"source"},{"url":"https://m.korea.kr/briefing/pressReleaseView.do?newsId=156775992\u0026pWise=mSub\u0026pWiseSub=C3","title":"Ministry of Health and Welfare announcement dated August 30, 2026: Payment of excess amounts for medical care received in 2025","type":"source"},{"url":"https://eiec.kdi.re.kr/policy/materialView.do?num=286003\u0026pg=\u0026pp=20\u0026topic=L","title":"KDI Economic Information and Education Center: Summary of the announcement on payment of excess amounts for medical care received in 2025","type":"data_point"},{"url":"https://www.law.go.kr/LSW/lsRvsDocListP.do;jsessionid=fxAr1BU-L1itlxJf6sFuECxM.LSW2?chrClsCd=010102\u0026lsId=001971","title":"Korean Law Information Center enactment and amendment texts for the National Health Insurance Act: Act No. 21522 and supplementary provisions","type":"source"},{"url":"https://www.nhis.or.kr/static/html/wbma/c/wbmac0209.html","title":"National Health Insurance Service out-of-pocket maximum system: Excluded items and payment methods","type":"source"},{"url":"https://www.nhis.or.kr/nhis/minwon/wbhaba03900m01.do?article.offset=0\u0026articleLimit=10\u0026articleNo=11001385\u0026mode=view\u0026srSearchVal=%EC%83%81%ED%95%9C%EC%A0%9C","title":"National Health Insurance Service out-of-pocket maximum system: Collection of application forms for retroactive refunds","type":"source"}],"images":[{"id":2052,"url":"https://onbinder.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6MzE2MTgsInB1ciI6ImJsb2JfaWQifX0=--d2878ce3a255e93e8106c02ade213a35912d8240/ai-91871109.webp","is_representative":true,"generation_method":"ai_photo","license":"ai_generated","mime_type":"image/webp","width":1536,"height":1024,"translations":{"ko":{"alt":"무릎 보조기를 찬 다리를 발받침에 올린 노년 남성이 창가에 앉아 탁자 위 스마트폰을 바라보는 모습","caption":"국민건강보험공단 누리집에서 환급 대상 여부와 신청 상태를 확인하세요.","description":null},"en":{"alt":"An older man rests his braced leg on a footstool and looks at a smartphone on a table beside the window.","caption":"Check reimbursement eligibility and application status on the National Health Insurance Service website.","description":null},"ja":{"alt":"膝に装具を着けた脚を足置きにのせ、窓辺の椅子からテーブルのスマートフォンを見る高齢男性","caption":"国民健康保険公団のウェブサイトで還付対象かどうかと申請状況を確認しましょう。","description":null},"es":{"alt":"Un hombre mayor descansa la pierna con rodillera sobre un reposapiés y mira el móvil en una mesa junto a la ventana.","caption":"Consulte si le corresponde un reembolso y el estado de su solicitud en la web del Servicio Nacional de Seguro de Salud.","description":null},"id":{"alt":"Pria lansia menopang kaki berpenyangga lutut di bangku dan melihat ponsel di meja dekat jendela.","caption":"Periksa kelayakan pengembalian biaya dan status pengajuan di situs Layanan Asuransi Kesehatan Nasional.","description":null},"pt":{"alt":"Um homem idoso repousa a perna com joelheira num apoio e olha para o celular na mesa junto à janela.","caption":"Consulte a elegibilidade para reembolso e o andamento da solicitação no site do Serviço Nacional de Seguro de Saúde.","description":null},"zh-hant":{"alt":"一名年長男子坐在窗邊，將戴著護膝的腿放在腳凳上，望向桌上的智慧型手機。","caption":"請至國民健康保險公團網站確認退款資格及申請進度。","description":null},"de":{"alt":"Ein älterer Mann legt sein Bein mit Knieorthese auf einen Fußhocker und blickt auf das Smartphone auf dem Tisch.","caption":"Prüfen Sie Ihren Erstattungsanspruch und den Antragsstatus auf der Website des Nationalen Krankenversicherungsdienstes.","description":null}}},{"id":2053,"url":"https://onbinder.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6MzE2MjcsInB1ciI6ImJsb2JfaWQifX0=--60c5528db10e25fe81a66e2b20169890befd9f71/ai-47bb187e.webp","is_representative":false,"generation_method":"ai_semi","license":"ai_generated","mime_type":"image/webp","width":1536,"height":1024,"translations":{"ko":{"alt":"서류가 놓인 병실 탁자 앞에서 중년 여성이 통화하고, 뒤편 침대에는 노년 여성이 누워 있다.","caption":"체납이 있다면 초과금 통보 시점과 공제 내역을 확인하세요.","description":null},"en":{"alt":"A middle-aged woman makes a phone call beside an elderly woman's hospital bed, with paperwork on the table.","caption":"If you have overdue premiums, check when the excess reimbursement was notified and what deductions apply.","description":null},"ja":{"alt":"書類が置かれた病室のテーブルの前で中年女性が電話をし、奥のベッドには高齢女性が横たわっている。","caption":"保険料の滞納がある場合は、自己負担上限超過額の通知時期と控除内容を確認してください。","description":null},"es":{"alt":"Una mujer habla por teléfono junto a la cama de una anciana hospitalizada, con documentos sobre la mesa.","caption":"Si tiene cuotas pendientes, revise cuándo se notificó el reembolso por exceso y qué deducciones se aplican.","description":null},"id":{"alt":"Perempuan menelepon di samping ranjang pasien lansia di rumah sakit, dengan dokumen di atas meja.","caption":"Jika ada tunggakan premi, periksa waktu pemberitahuan pengembalian kelebihan biaya dan rincian potongannya.","description":null},"pt":{"alt":"Uma mulher fala ao telefone ao lado da cama de uma idosa hospitalizada, com documentos sobre a mesa.","caption":"Se houver contribuições em atraso, confira quando o reembolso do excedente foi comunicado e quais deduções se aplicam.","description":null},"zh-hant":{"alt":"一名中年女子在病房桌前講電話，桌上放著文件，後方病床上躺著一名年長女子。","caption":"若有積欠保費，請確認自付額超額退款的通知時間及扣抵明細。","description":null},"de":{"alt":"Eine Frau telefoniert neben dem Krankenhausbett einer älteren Frau; auf dem Tisch liegen Unterlagen.","caption":"Prüfen Sie bei Beitragsrückständen den Zeitpunkt der Mitteilung zur Erstattung und die vorgenommenen Abzüge.","description":null}}}],"published_at":"2026-10-23T00:59:43+09:00","updated_at":"2026-10-23T00:59:43+09:00","license":"cc_by","translation_status":"reviewed","available_locales":["ko","en","ja","es"],"data_locales":["ko","en","ja","es","id","pt","zh-hant","de"],"url":"https://onbinder.com/en/articles/medical-copayment-cap-refund-2026-arrears-check"}