Park, a 68-year-old resident of Daegu, recently received a text message from the National Health Insurance Service about a refund for medical costs exceeding the annual out-of-pocket ceiling. "I read the message, but I could not understand what it meant," Park said. "I plan to ask my son when he comes home for the Chuseok holiday."
Refunds worth 50.6 billion won under South Korea's out-of-pocket ceiling system, which returns excessive medical expenses to patients, went unpaid over the past three years.
Of the excess payments approved between 2020 and 2022, a total of 50.597 billion won had expired under the statute of limitations as of the 9th of this month, according to data the NHIS submitted to Rep. So Byung-hoon of the Democratic Party of Korea, a member of the National Assembly's Health and Welfare Committee, on the 23rd. A total of 63,994 people failed to receive the money, or about 790,000 won each.
Under the out-of-pocket ceiling system, designed to ease household medical burdens, the NHIS covers and refunds any amount by which a subscriber's annual co-payments — medical costs paid by patients, excluding uninsured and selectively covered services — exceed an individual ceiling, which ranged from 890,000 won to 10.74 million won last year. The refunds go to subscribers and their dependents.
Excess payments from 2023 onward have not yet reached the statute of limitations. Refunds approved between 2023 and this year but still unpaid totaled 332.249 billion won, covering 368,577 people.
Of that amount, 325.787 billion won, or 98.1%, was classified as "pending application reminders," meaning the money could not be paid because recipients had not completed the application process.
The NHIS said it sends an initial notice on how to apply, followed by a second notice three months later to those who have not applied, and a third notice three months before the statute of limitations expires. The agency said it also reaches out periodically by phone, text message and messaging app.
"If the agency sent notices and text messages repeatedly but still failed to deliver the payments, it is hard to say it has fulfilled its responsibility," So said. "The agency should actively contact those whose claims are about to expire and help older adults and people with disabilities file their applications." He added, "In the longer term, it needs to devise a way to refund the money without requiring a separate application."
