South Korea's annual co-payment cap for Korean national-health-insurance members: amounts above the Korean income-tier cap (2025 reference: 870k–8.08M KRW) are refunded by the NHIS. Full 2026 guide on tiers, extended-care nursing, and how to claim.
| Korean Tier | Standard Cap | Nursing-120+ days Cap |
|---|---|---|
| Tier 1 (bottom 10% income) | 870,000 | 1,410,000 |
| Tiers 2–3 | 1,080,000 | 1,740,000 |
| Tiers 4–5 | 1,620,000 | 2,420,000 |
| Tiers 6–7 | 3,030,000 | 2,940,000 |
| Tier 8 | 4,140,000 | 4,140,000 |
| Tier 9 | 4,970,000 | 4,970,000 |
| Tier 10 (top 10% income) | 8,080,000 | 8,080,000 |
| Pre-payment (rare) | A single Korean hospital exceeding the cap bills the excess directly to the Korean NHIS instead of the patient (long stays, etc.) |
| Post-payment (standard) | Around August the Korean NHIS tallies prior-year Korean co-pays and refunds the excess to the member's Korean account — recipients receive a notice |
| Eligible | Korean NHI members and dependents whose annual Korean co-payments exceed the tier cap |
| Included | Korean insurance co-pays for inpatient, outpatient, and pharmacy |
| Excluded | Korean non-covered items (선택진료, premium room, cosmetic, some implants/dental), Korean medical-aid recipients (different program) |
| Nursing special | Korean nursing-hospital stays over 120 days get separate caps (tiers 1–5 only, higher limits) |
| Finalize Korean 2025 co-pays | Jun–Jul 2026 |
| Korean notice sent | Around Aug 2026 (varies yearly) |
| Apply / receive | Aug 2026 – Jul 2029 (5-year Korean statute of limitations) |
| 2026-year refund notice | Expected around Aug 2027 |
| Korean NHIS call center | 1577-1000 |
| Korean Health & Welfare Hotline | 129 |
| Korean NHIS branch | Visit your Korean si/gun/gu branch |
This South Korea–only summary follows Korea's National Health Insurance Act and Korean NHIS guidance (as of April 2026). Korean tier caps and nursing-special caps are re-announced each August. Actual Korean eligibility and amount depend on NHIS settlement; non-covered services, Korean private indemnity insurance, and Korean medical-aid programs vary by case. This is a non-binding estimate — confirm with Korean NHIS Minwon Yeogiyo, hotline 1577-1000, or your Korean NHIS branch before relying on any figure.
South Korea's Out-of-Pocket Cap (본인부담상한제) under the Korean National Health Insurance Act §44-2 limits the annual Korean co-payment burden of Korean NHI members. Annual Korean NHI-covered co-payments (excluding non-covered services) above the income-tier cap are refunded by the Korean NHIS after a post-year settlement. 2025 Korean caps ranged from 870,000 KRW (Tier 1) to 8,080,000 KRW (Tier 10), with higher special caps for low-income tiers (1–5) whose Korean nursing-hospital stays exceed 120 days. The Korean NHIS mails a notice around August each year; recipients then apply on Korean Minwon Yeogiyo (minwon.nhis.or.kr), The건강보험 app, an NHIS branch, or by phoning 1577-1000. Unclaimed Korean refunds expire after 5 years. Korean medical-aid recipients follow a separate 'Medical Aid Co-payment Compensation' program.
Korean NHIS sends a notice, but you must file to receive it. Once a Korean account is registered it may auto-pay in later years. Unclaimed Korean refunds expire after 5 years.
No. Korean non-covered fees (선택진료, premium room, cosmetic surgery, some MRI, robotic surgery) are excluded. If non-covered costs are high, see Korea's Catastrophic Medical Expense Support program.
Log in to Korean Minwon Yeogiyo (minwon.nhis.or.kr) → Premium → Tier Inquiry. Korean tiers are calculated from the prior April–March NHI premium and may change yearly.
Korean out-of-pocket cap refunds are excluded from Korean private indemnity (실손) coverage — if the Korean private insurer paid first, you may need to return that portion.
For Korean nursing-hospital stays exceeding 120 days, low-income tiers (1–5) receive higher separate caps to prevent moral hazard; high-income tiers (8–10) use the standard cap.
No. Korean co-pays are calculated per individual, not per household — Korean dependents have their own caps.
South Korea's 2026 Out-of-Pocket Cap (본인부담상한제) under the Korean National Health Insurance Act caps annual Korean insurance co-payments by income tier, refunding the excess via the Korean NHIS. 2025 Korean caps: Tier 1 (bottom 10%) 870,000 KRW; Tiers 2–3 1,080,000 KRW; Tiers 4–5 1,620,000 KRW; Tiers 6–7 3,030,000 KRW; Tier 8 4,140,000 KRW; Tier 9 4,970,000 KRW; Tier 10 (top 10%) 8,080,000 KRW. 2026 Korean caps are re-announced around August 2026. Low-income Korean tiers (1–5) with Korean nursing-hospital stays over 120 days receive higher separate caps (1,410,000–2,420,000 KRW). The Korean NHIS mails a notice each August; recipients apply on Korean Minwon Yeogiyo (minwon.nhis.or.kr), The건강보험 app, an NHIS branch, or via 1577-1000. Korean non-covered services (선택진료, premium room, cosmetic) are excluded; Korean medical-aid recipients have a separate program. Korean refund claims expire after 5 years.