Even those eligible for refunds of health insurance out-of-pocket ceiling excess amounts face a different situation if they have overdue premiums. Starting October 8, 2026, overdue premiums will be deducted first, and only the remaining amount will be paid.

■ Overdue Premiums Deducted First... Basis Is Amended Health Insurance Act Article 44

If hospital visits and outpatient treatment continued last year, resulting in heavy medical bills, any portion of the out-of-pocket payments made over the course of a year that exceeded the income-based ceiling can be refunded by the National Health Insurance Service (NHIS). However, for those who have delayed applying while having overdue premiums, after October 8, 2026, the overdue amount will be deducted first at the payment stage, and only the remainder will be deposited into their accounts.

The basis for this change is Article 44, Paragraph 3 of the amended National Health Insurance Act. Once this provision takes effect, when the NHIS pays out the out-of-pocket ceiling excess amount, it may deduct any overdue premiums or collectible amounts under the same act before payment. The Ministry of Health and Welfare, as it began the payment process for excess amounts from last year's treatment, advised those with overdue amounts to take note of this point.

■ Payments Proceed in Two Tracks... Those Registered with Payment Consent Accounts Receive Payment Without Separate Application

With the implementation date approaching, payments are proceeding along two tracks. For those who pre-registered a payment consent account, sequential payments have been made without a separate application. The rest must apply directly after receiving a notification letter to receive payment. Among these, how many have not yet applied, and how many of those have overdue premiums, has not been disclosed.

■ If Overdue Amount Exceeds Refund, There May Be No Remaining Amount

Individual refund amounts vary depending on the income-tier ceiling and the actual out-of-pocket payments made. If the overdue amount exceeds the refund, there may be no remaining amount after deduction.

The timing of the deduction's application is still unclear. The official announcement only stated that it applies to payments made after the implementation date. Whether deductions apply if an application was completed before the implementation date but the actual deposit occurs after it has not been confirmed.

■ Those with Overdue Amounts Should Check Overdue Balances and Application Criteria at the Customer Center

Those with overdue amounts need to check both their overdue balance and the application criteria through the NHIS customer center. Applications can be made via the NHIS website, mobile app, phone, fax, mail, or by visiting a branch office.

It is not yet known whether the NHIS will provide additional guidance on whether the application date or the payment date after implementation will be used as the standard, or whether the actual number and amount of deductions will be disclosed. There is also the remaining concern that missing the application deadline may result in not receiving payment.

[This article is an informational piece based on official announcements from the Ministry of Health and Welfare and the National Health Insurance Service. Detailed payment criteria and schedules may change with policy changes. Individual refund eligibility and amounts must be confirmed through the National Health Insurance Service. AI assisted in part.]