Major Review of Health Insurance Benefit Criteria... Strengthening Qualification Requirements for Foreigners

'Measures to Enhance the Sustainability of Health Insurance' Confirmed
Major Overhaul Expected Across All Areas

Park Min-su, the 2nd Vice Minister of Health and Welfare, is presiding over the Health Insurance Policy Deliberation Committee on the 28th.
[Photo by Ministry of Health and Welfare]

The coverage criteria for magnetic resonance imaging (MRI) and ultrasound will be reviewed, and the eligibility requirements for health insurance for foreign dependents will be further strengthened. Along with enhancing the collection and management of health insurance premiums, various measures to ensure financial soundness, such as appropriate management of non-covered services and rationalization of the out-of-pocket maximum system, will also be pursued.

The Health Insurance Policy Deliberation Committee received and finalized the "Measures to Enhance the Sustainability of Health Insurance" on the 28th, which includes these contents. Accordingly, a major overhaul of the previous administration’s coverage expansion policy, represented by the so-called "Moon Jae-in Care," is expected.

First, a large-scale re-examination of coverage criteria and items will be conducted based on medical necessity. The expansion of MRI and ultrasound coverage, identified as a representative issue, will have clearer criteria focused on items related to abnormal findings. For example, brain and cerebrovascular MRI coverage will be recognized only when there are abnormal findings in neurological examinations, and the current maximum of 3 scans will be limited to 2 scans. For musculoskeletal and other MRI and ultrasound services, limited coverage will be promoted focusing on essential items after reviewing medical validity. Additionally, non-covered or criteria-based coverage will be re-evaluated for medical usefulness, therapeutic effectiveness, and financial burden to decide on coverage inclusion.

The eligibility requirements for foreign dependents, a major factor contributing to the deterioration of health insurance finances, will also be strengthened. A mandatory minimum stay period of 6 months will be established for foreign dependents to prevent entry for medical purposes. However, spouses and minor children will be allowed to acquire eligibility immediately upon entry as currently practiced. Furthermore, permanent residents who have been abroad for an extended period (unreported overseas migrants) and enter the country as regional subscribers will only be eligible for health insurance after 6 months of entry. Exceptions will be made for long-term overseas residents such as international students and expatriates who are non-permanent residents, allowing them to use health insurance immediately upon entry as at present.

Health insurance premium imposition and collection management will also be strengthened. The income adjustment system for regional subscribers will be maintained, but if income is confirmed retrospectively after premium adjustment, the difference will be settled. High-income long-term delinquents will be selected as special management targets for focused management, and the provision of delinquent information to the Credit Information Agency will be expanded to encourage voluntary payment. Currently, only workplace delinquents’ information is provided, but this will be extended to regional subscriber delinquents (delinquent for over 1 year, over 5 million KRW).

Along with this, to strengthen the management of non-covered services, improvements to indemnity insurance will be pursued, and measures to expand the provision of related information to consumers will be implemented. Additionally, measures to reduce excessive medical use, such as considering a differentiated out-of-pocket rate system based on outpatient medical usage, will also be explored.

Based on this finalized plan from the Health Insurance Policy Deliberation Committee, the government stated that short-term tasks feasible to implement this year will be expedited, and mid- to long-term structural reform plans will be concretized through sufficient communication with the medical community and the public, then reflected in the "Comprehensive Health Insurance Plan" to be announced in the second half of this year.

This content was produced with the assistance of AI translation services.