[Asia Economy Yeongnam Reporting Headquarters Reporter Kim Yong-woo] The Busan-Ulsan-Gyeongnam Regional Headquarters of the National Health Insurance Service announced on the 29th that it has finalized the out-of-pocket maximum amounts based on income levels for medical expenses borne by individuals last year.
They lowered the threshold amounts and continuously expanded non-covered items to covered items so that more subscribers can benefit from the out-of-pocket maximum system.
Accordingly, the relevant nationals will receive refunds for medical expenses exceeding the 2020 out-of-pocket maximum amount.
The out-of-pocket maximum system is a program where the National Health Insurance Service pays the excess amount when the annual personal co-payment (excluding non-covered and selective benefits, i.e., medical expenses borne by the patient) exceeds the individual limit based on income level, to alleviate the economic burden caused by excessive medical expenses.
The National Health Insurance Service analyzed that since 2018, the threshold for the out-of-pocket maximum amount was lowered from 1.24 million KRW to 800,000 KRW for the bottom 10% income group (1st quintile), and non-covered items such as medically necessary abdominal and chest MRI (since November 2019) and gynecological ultrasound (since February 2020) have been continuously expanded into covered items.
The number of eligible recipients and the amount paid under the out-of-pocket maximum system have been increasing every year.
In particular, the number of eligible recipients and the amount paid for those in the bottom 50% income group were 1,396,259 people and 1.5337 trillion KRW, respectively, accounting for 84.1% of all eligible recipients and 68.3% of the total amount paid.
By age group, those aged 65 and over accounted for 847,943 people and 1.4369 trillion KRW, representing 51.0% of all recipients and 64.0% of the amount paid, indicating that the effect of reducing medical expenses for the elderly and low-income groups continues to appear.
The refund targets in the Busan-Ulsan-Gyeongnam region are 272,067 people and 288.2 billion KRW. Those who received the “Out-of-Pocket Maximum Excess Payment Application Guide” sent by the Service starting August 23 can apply for a refund to their own account via phone, fax, mail, or internet through the National Health Insurance Service.
Director Jang Su-mok said, “Since the entire nation is facing difficulties due to the COVID-19 crisis, we will do our best to ensure that the excess out-of-pocket payments are paid promptly to help households.”
Director Jang added, “We will continue to expand the catastrophic medical expense support project, which supports households with excessive non-covered medical expenses, and the out-of-pocket maximum system, which has a significant effect on supporting low-income groups, to more faithfully fulfill the role of the medical safety net.”
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