If you spent an unusually large amount on hospital bills last year, you may have money coming back to you. This is because amounts paid to hospitals that exceed certain thresholds can be refunded. The Ministry of Health and Welfare and the National Health Insurance Service have finalized the individual out-of-pocket maximum for 2025 medical care and began the excess payment disbursement process on August 31. This round covers 2,262,605 people, with total payments of 3.076 trillion won and an average refund of approximately 1.36 million won per person.

■ Am I eligible? Check your health insurance out-of-pocket costs first

The first thing to check is how much you actually paid out of pocket among the medical costs covered by health insurance last year. If this amount exceeded your individual out-of-pocket maximum, you can receive a refund of the excess.

However, not all medical expenses are included even if you spent heavily on hospital bills. Some items, such as non-covered services and selectively covered benefits, are excluded; eligibility is determined based on the amount you paid out of pocket for health insurance-covered care.

The 2025 individual out-of-pocket maximum ranges from 890,000 won to 10.74 million won. Because the cap varies by income level and other factors, even people who spent the same amount on medical bills may differ in refund eligibility and amount. If your health insurance out-of-pocket payments exceeded your individual cap, the difference may be refundable.

■ Lower-income and elderly groups account for large shares

This round of refunds is concentrated among lower-income and elderly groups. Recipients in the bottom 50% income bracket numbered 2,016,503, or 89.1% of all recipients, and the amount paid to them totals 2.3556 trillion won, or 76.6% of total payments. Those aged 65 or older number 1,310,761, accounting for 57.9% of the total, with payments totaling 2.0596 trillion won.

■ Registered payment account is key... disbursement begins September 2

If you have been notified that you are eligible, the next thing to check is whether you have a registered payment consent account. The 1,312,819 people who have registered one will receive the excess payments sequentially from September 2 into their pre-registered accounts in their own names, without a separate application.

Those without a registered payment consent account must apply directly. The National Health Insurance Service is sending payment application notices to eligible individuals. Starting this year, electronic documents are sent first via Naver Electronic Documents, the KT PASS app, and KakaoTalk, with postal notices sent to those who do not use or check electronic documents. Upon receiving a notice, you can apply for payment to an account in your own name through the NHIS website, the Health Insurance 24/7 mobile app, fax, phone, mail, or in person.

The absence of a notice does not necessarily mean you are ineligible. You may not have checked your electronic documents, the postal notice may still be in transit, or the timing may vary depending on your individual settlement status. If your medical expenses were substantial last year, it is best to verify your eligibility directly with the National Health Insurance Service.

■ Register once and future payments are automatic

Once you register a payment consent account, the process becomes simpler in the future. If you consent to the payment consent account application item during this refund process, any future out-of-pocket maximum excess payments will be automatically deposited into your registered account without a separate application.

■ Summary of verification steps

The verification order is simple: ▲ Whether you spent heavily on hospital bills last year ▲ Whether your health insurance out-of-pocket payments exceeded your individual cap ▲ Whether you received a notice from the NHIS ▲ Whether you have a registered payment consent account

Check these items in order. The average refund of 1.36 million won does not mean everyone receives the same amount. But with more than 2.26 million people eligible, households that faced heavy medical burdens last year should check whether they qualify for a payment.

[※ This article was written to aid understanding of the system based on materials released by the Ministry of Health and Welfare and the National Health Insurance Service. Individual refund eligibility and amounts may vary depending on income level, health insurance-covered medical costs, advance benefit status, and insurance premium arrears, so please verify actual payment details through the NHIS's official notices and lookup results. This article was written with AI assistance.]