The period for easing out-of-pocket costs for outpatient treatment for preterm infants will be extended, and the cap on rewards for reporting fraudulent claims to the national health insurance will be raised. The exemption period for out-of-pocket costs for follow-up visits and tests after a general health screening will also be extended.
The Ministry of Health and Welfare said on the 16th that the Cabinet approved a partial amendment to the Enforcement Decree of the National Health Insurance Act containing these measures.
Under the amendment, the period for reducing out-of-pocket costs for outpatient care for preterm infants will be extended and applied differentially, taking into account gestational age at birth (the length of time the fetus remained in the uterus). Until now, all preterm infants were uniformly subject to a 5% out-of-pocket rate for outpatient treatment from birth until age 5. After the change, the reduction period will be extended to up to 5 years and 4 months depending on gestational age.
Specifically, for gestational age of at least 33 weeks but less than 37 weeks, the reduction applies for 5 years and 2 months; for at least 29 weeks but less than 33 weeks, 5 years and 3 months; and for less than 29 weeks, up to 5 years and 4 months. The ministry said it expects this to meaningfully reduce medical costs for preterm infants and their caregivers.
The reward program for reporting fraudulent claims to the national health insurance will also be revised. Previously, the calculation standard and cap for rewards varied by the type of informant, but going forward a single standard will apply regardless of the reporter's category. The reward cap will also be raised to 3 billion won from the previous 2 billion won. The ministry said, "This measure aims to curb leakage of health insurance finances and enhance the system's sustainability by activating reporting."
The exemption period for out-of-pocket costs for additional visits and tests following general health screenings will also be extended. Previously, out-of-pocket costs were waived once until Jan. 31 of the year after the screening, but this will be extended by two months to Mar. 31. The change is intended to reduce inconvenience for examinees, reflecting the reality that screenings are concentrated at year-end.
At the same time, the 2026 health insurance premium rates were reflected in the decree. The premium rates for workplace and regional subscribers will rise to 7.19% from 7.09%, and the amount per assessment point for property-based premiums for regional subscribers will increase to 211.5 won from 208.4 won. This follows a decision by the Health Insurance Policy Deliberation Committee this year.
The amendment takes effect upon promulgation, but the adjustment to the reduction period for preterm infants' outpatient out-of-pocket costs and the application of the 2026 premium rates will take effect on Jan. 1 next year.
Lee Jung-gyu, director general for health insurance policy at the ministry, said, "This revision to the enforcement decree will help ease the burden on preterm infants and health screening examinees and enhance the stability of health insurance finances."