1. Reasons for Proposal

The Amendment adjusts the co-payment ceiling for the insured earning an income above a certain amount to match their actual payment capacity, thereby enhancing the fairness of the co-payment ceiling system. It specifies grounds for early seizure of unjust enrichment and unjust profit collectible as delegated by the Act, as well as the scope of concealed property for which a reward may be paid to informants. It includes business category (occupation) as a personal detail disclosed upon failure to pay a large amount of health insurance contributions or upon habitual failure to pay health insurance contributions, thereby aiming to ensure that the disclosure of personal details, as intended, encourages payment of health insurance contributions.

2. Major Provisions

A. Exclude from the co-payment ceiling system outpatient care at a tertiary hospital for a mild illness (Article 19 (3))

B. Specify grounds on which to seize unjust enrichment and unjust profit collectible, and to lift a seizure of property (Article 46-6 newly inserted)

Prescribe grounds on which to seize unjust enrichment and unjust profit collectible, including compulsory collection due to default of national taxes, etc., dissolution of a corporation, and cases where the amount to be collected is 500 million won or more. Specify as grounds to lift a seizure cases where a not guilty verdict is confirmed, and cases where indictment is canceled.

C. Prescribe measures for the payment of rewards to persons who report property concealed by unlawfully established health care institutions (Article 75 (1) and (6), attached Table 6)

1) Add persons who intend to report concealed property to the scope of persons who shall comply with reporting procedures and methods specified by the National Health Insurance Service

2) Prescribe that domestic property that has been registered in the name of a person who is required to pay an amount for collection under Article 57 of the Act shall be excluded from the scope of payment of rewards to informants

3) Prescribe reward amounts based on the amounts to be collected

D. Expand the scope of disclosure of personal details on persons in arrears (Article 48 (4)) 

Add “business category (occupation)” to the scope of personal details disclosed upon failure to pay a large amount of health insurance contributions or upon habitual failure to pay health insurance contributions

E. Adjust the co-payment ceiling for high income earners and specify a separate upper limit for high income earners upon long-term hospitalization at a long-term care hospital (attached Table 3)

F. Clarify grounds for requesting data held by the Korea Customs Service in relation to human tissue used as materials for medical treatment (attached Table 4-3)