Unpaid health premiums can be deducted from out-of-pocket cap refunds — effective 8 October 2026 | offset by the arrears
When a year's out-of-pocket medical costs exceed the cap, the National Health Insurance Service refunds the excess. Today the refund is paid in full even to someone in arrears, but from 8 October 2026 the Service may deduct unpaid premiums and collections from the refund before paying it. It applies to excess amounts notified on or after the effective date.
Conditions used in the video
- Effective date
- 2026-10-08
- Promulgated
- 2026-04-07
- Basis
- National Health Insurance Act Article 44(3) (new)
- Money concerned
- refund of costs above the out-of-pocket cap
- What is deducted
- unpaid premiums · collections
- Applies to
- excess amounts notified on or after the effective date
Results
- Now
- refund paid in full even with arrears
- From 2026-10-08
- may be paid after deducting the arrears
- Cap
- by income level · Presidential Decree
- Nature of the rule
- discretionary (the Service decides)
- Notification and payment
- the Service
Why it works this way
Under the out-of-pocket cap, when a year's medical costs borne by the patient exceed the cap for their income level, the Service refunds the excess. Today that refund is paid in full even if the person is behind on premiums. Money owed to you and money you owe were not set off against each other.
National Health Insurance Act Article 44(3) (effective 2026-10-08).
- Excess above the capthe amount the Service would refund
- Unpaid premiums and collectionsdeducted by that much
- Paidwhat remains after the deduction
'May deduct and pay' is a discretionary provision. The deduction is not automatic.
The cap system itself does not change. The cap varies by income level and is set by Presidential Decree, and the Service notifies and pays the excess. The only change is that the notified amount may be reduced by any arrears.
Addenda Article 2 (application).
- On or after 2026-10-08excess amounts notified
- Notified before thenpaid in full as before
- Decisionthe Service
The reference point is when the Service notifies the excess, not when the medical costs were incurred.
This video and page describe a measure that has been promulgated but has not taken effect. Details may change through a decree or notice.
In short, from 8 October 2026 an out-of-pocket cap refund may be paid after deducting unpaid premiums. Anyone in arrears should re-check the notified refund amount.
The legal basis
Drawn from government announcements and the statutes themselves as primary sources, covering only the relevant part.
National Health Insurance Act Article 44(3) (Partial cost-sharing: deduction from excess amounts)
In force Effective 2026-10-08 (promulgated 2026-04-07; Addenda Article 1)
When paying the amount exceeding the out-of-pocket cap, the Service may deduct any premiums or collections the insured has failed to pay and pay the remainder.
What this means
Money owed to you and money you owe are settled in one place. Anyone waiting for a refund should check their arrears first.
National Health Insurance Act Addenda Article 2 (Application)
In force 2026-10-08
Article 44(3) applies to excess amounts notified on or after the date this Act takes effect.
What this means
The reference date is the notification date. Refunds notified before the effective date are paid in full as before.
Run it on your own numbers
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Frequently asked
Do I lose the refund if I am in arrears?
You receive what remains after the arrears are deducted. If the refund exceeds the arrears, the difference is paid.
Is the deduction mandatory?
The Act says the Service 'may deduct and pay'. It is discretionary and follows the Service's judgment.
What is the cap?
It differs by income level and is set by Presidential Decree. Check that year's cap table with the Service.
Are medical costs incurred before the effective date affected?
The reference point is when the Service notifies the excess, not when the costs were incurred. It applies to notifications on or after the effective date.
Results are estimates based on the inputs and on the rules as at the stated date. They may differ from a lender's actual assessment, and the rules change often. Take professional advice before any decision that matters.