Even if you are owed money back under the out-of-pocket maximum system (refund), you may not receive the full amount you expect if your health insurance premiums are in arrears. Starting October 8, the National Health Insurance Service (NHIS) will implement a system allowing it to first deduct unpaid premiums or collection charges from excess payments—amounts exceeding the annual out-of-pocket maximum that must be paid back to subscribers. As a result, even among those eligible for the same excess payment, the amount actually deposited into their accounts may vary depending on whether they have arrears, making it necessary for subscribers awaiting refunds to check their status.

[Legal Basis: Newly Established Article 44, Paragraph 3 of the National Health Insurance Act]

The basis is the Partial Amendment to the National Health Insurance Act (Act No. 21522), promulgated on April 7. The amendment created a new Paragraph 3 under Article 44, stipulating that if a party is in arrears on premiums or collection charges under the Act, the NHIS may deduct the delinquent amount from the excess payment before disbursing it. The supplementary provisions set the effective date as "the day six months after promulgation," fixing it as October 8. However, since the clause states the NHIS "may deduct and pay," the decision on whether to deduct is left to the discretion of the NHIS.

[Why It Was Created... The Gap Where Refunds Were Paid in Full to Delinquent Subscribers]

The out-of-pocket maximum system requires the NHIS to refund the portion by which a subscriber's total annual out-of-pocket health insurance payments exceed the income-based cap. The problem was that these refunds were paid out in full even to subscribers with long-standing premium arrears. According to data submitted by the NHIS to the National Assembly, approximately 3.9 billion won in excess payments was paid to 4,089 high-amount, long-term delinquents between 2021 and 2024. This amendment aims to close that gap.

[This Year's Excess Payments Begin August 31... Electronic Documents Sent First as Notice]

The timing also aligns. With the 2025 individual out-of-pocket maximums now finalized, the Ministry of Health and Welfare and the NHIS began the excess payment process on August 31. From this year, notices are first sent as electronic documents via Naver, the PASS app, and KakaoTalk in that order, with mailed notices sent only to those who do not use or open them. The Ministry and NHIS stated that for excess payments made after the effective date, any arrears will be deducted before payment. For recipients who have not yet applied, arrears status becomes a variable determining the actual amount received. However, what standards apply to excess payments already notified before the effective date requires confirmation from the NHIS.

[How to Check and Apply, and the Three-Year Expiration Period]

Excess payments can be checked and applied for through the refund inquiry and application menu on the NHIS website or "The Health Insurance" app. By checking the "payment consent account" box on the application and submitting it, future excess payments will be automatically deposited into the registered account without a separate application. Under Article 91 of the National Health Insurance Act, the right to a refund expires three years after it becomes exercisable.

Since notices are now sent first as electronic documents, it is safer to check directly through the official website or app in order to distinguish them from text messages impersonating the NHIS with internet links.

[This article is policy information based on the amended National Health Insurance Act and guidance from the Ministry of Health and Welfare and the National Health Insurance Service. Whether deductions apply and payment amounts may vary depending on individual arrears and notification timing. Detailed standards may change according to NHIS policy. AI assisted in part.]