Within the same year, hospital bills for patients admitted to a general hospital and those admitted to a nursing hospital follow a different pattern. For general hospital patients, once the health insurance-covered copayment reaches a certain amount, no further charges are billed. In contrast, the bills of nursing hospital patients have no such 'stop.'

This is because the out-of-pocket maximum system operates differently depending on the type of hospital.

■ General hospitals use 'advance benefits'... nursing hospitals excluded since 2020

At general hospitals, if a patient's copayments at a single facility exceed the maximum cap, the hospital bills the National Health Insurance Service (NHIS) directly for the excess. This is called 'advance benefits.'

However, since January 1, 2020, the NHIS has excluded nursing hospitals from the advance benefit system. Nursing hospital inpatients continue paying copayments at the counter even after exceeding the cap, and the excess is refunded the following year through post-payment reimbursement.

■ Separate cap applies when hospitalization exceeds 120 days

The cap that serves as the basis for the refund amount also differs. If the nursing hospital stay exceeds 120 days, a separate, higher cap than the standard one applies. Therefore, even patients in the same income bracket may receive different refund amounts depending on whether their stay exceeded 120 days.

■ How to check and apply for health insurance refunds

Health insurance refunds can be checked on the NHIS website or through the Health Insurance 24 app. Applications can also be made by visiting a branch office, by fax, or by mail.

When applying on behalf of a hospitalized family member, the required documents may differ, so the NHIS should be consulted before filing.

■ Why the checked amount may differ from the total of receipts

The amount shown in the lookup may differ from the total of accumulated medical receipts. The NHIS explains that the copayment printed on medical receipts may differ from the amount calculated by the service due to items excluded from the cap system or national and local government medical subsidy support.

Therefore, for family members with long nursing hospital stays, it is more accurate to check refund results based on the NHIS calculation rather than the total receipt amount.

[This article is general information summarizing how the out-of-pocket maximum system applies to nursing hospital inpatients, based on the NHIS operating standards. Individual caps and refund amounts vary depending on income bracket, length of stay, and NHIS calculations, and the system may be revised, so final confirmation should be made through official NHIS channels. AI-assisted in part.]