The refund process for health insurance out-of-pocket cost ceiling excess amounts for 2025 medical treatments has begun. However, not all refund recipients will receive their money in the same way. Depending on whether they have registered a payment-consent account, they are divided into those eligible for automatic deposits and those who must apply directly.

▲ 2.26 Million Eligible for Refunds... 1.31 Million to Receive Automatic Deposits Without Separate Application

According to the Ministry of Health and Welfare and the National Health Insurance Service (NHIS), a total of 2,261,271 people are eligible for retroactive payment of out-of-pocket ceiling excess amounts for 2025 medical treatments. Of these, 1,312,819 people, or about 58%, have registered payment-consent accounts — nearly 6 out of every 10 people.

The NHIS began sequentially paying the excess amounts into registered accounts for these individuals starting September 2, without any separate application procedure.

A payment-consent account is a system that allows people to pre-designate an account to be used when out-of-pocket ceiling excess amounts occur. Once registered, future refunds can be deposited into that account without a separate payment application. Even those with no excess amount to be refunded currently can register in advance through the NHIS customer center.

▲ Those Without Registered Accounts Must Apply Directly... Eligibility Can Be Checked on Website and App

Conversely, eligible individuals who have not registered a payment-consent account must apply directly. After checking the payment application notice sent by the NHIS, they can apply using an account in their own name, and the payment process will proceed.

Refund eligibility and amounts can be checked on the NHIS website or the Health Insurance 25 app. In addition to online channels, applications can also be made by phone, fax, mail, or by visiting an NHIS branch office.

▲ Over Half Are Aged 65 or Older... Accounting for 67% of Total Payment Amount

In this round of refunds, recipients aged 65 or older make up more than half. Those aged 65 and above number 1,310,761, accounting for 57.9% of all recipients, and the amount going to them is 2.096 trillion won, equivalent to 67% of the total payment amount.

However, the announcement did not separately disclose how many of those aged 65 or older have registered payment-consent accounts. Therefore, it is difficult to interpret the automatic payment rate for the elderly as being identical to the overall payment-consent account registration rate among all recipients.

▲ Revised Law Takes Effect October 8... New Legal Basis Established for Deducting Arrears

In October, changes will also take place in relevant legislation. When the revised National Health Insurance Act takes effect on October 8, a legal basis will be applied allowing the NHIS to deduct arrears from the excess amount before payment when a person who has defaulted on insurance premiums or collections under the National Health Insurance Act becomes eligible for an out-of-pocket ceiling excess payment.

The timing of application needs to be distinguished. It does not apply to all cases where actual refunds are deposited after October 8. According to the supplementary provisions of the revised law, the regulation applies from cases where the out-of-pocket ceiling excess amount is notified after the law takes effect.

Moreover, the law does not mandate the deduction of arrears; it stipulates that the NHIS 'may deduct and pay' the arrears from the excess amount. Therefore, caution is needed before concluding that a refund will necessarily be deducted simply because of arrears.

▲ First Things to Check: 'Refund Eligibility and Account Registration'

Ultimately, the first things to check in this refund round are whether one is eligible for payment and whether a payment-consent account has been registered. If registered, payment can be made without a separate application, but if not, one must check the notice and go through the application procedure.

The government announcement did not separately explain the detailed automatic payment procedures for cases where an account was changed or canceled after registering a payment-consent account. If this applies to you, it is necessary to verify the actual payment account and processing status through the NHIS.

[Out-of-pocket ceiling refund eligibility, payment amounts, and payment methods may vary by individual. Actual refund status and application procedures should be confirmed through official NHIS guidance. This article was written based on publicly available materials, with AI providing partial assistance in the writing process.]