Starting next year, if you receive more than 300 outpatient visits in a year, the coinsurance rate for National Health Insurance will rise to 90% beginning with the 301st visit. For patients who go back and forth among multiple medical institutions, a system will also be put in place to allow providers to check tests and treatments received at other hospitals during care.
The Ministry of Health and Welfare said that a revision to the Enforcement Decree of the National Health Insurance Act with these details was approved at a Cabinet meeting on the 8th. The revision will take effect after promulgation procedures.
Currently, a 90% coinsurance rate is applied to outpatient visits exceeding 365 per year, but starting next year the threshold will be lowered to 300 visits. Three hundred visits a year is roughly the level of visiting a medical institution about six times a week.
However, patients for whom frequent visits are unavoidable are exceptions. Children, pregnant women, and patients with severe, rare, or severe intractable diseases remain excluded as before. Even if a person is not in an exception category, if medical necessity is recognized, additional exceptions can be granted after review by the National Health Insurance Service.
In reality, there are not many people who receive very high-frequency outpatient care. Among about 48.4 million outpatient users in 2025, 7,765 exceeded 300 visits per year. Their average annual number of outpatient visits was 344.7. There was also a case of 1,775 outpatient visits in a year.
The government lowered the threshold to manage excessively frequent outpatient use while reducing patient safety issues from repeated or duplicate care.
A system will also be built to allow checking care records from other medical institutions at the point of care. Currently, when a patient uses multiple hospitals, each hospital has difficulty confirming tests or treatments received elsewhere. As a result, identical or similar tests and prescriptions could be repeated.
The "benefit details verification system" will first apply to computed tomography (CT) and magnetic resonance imaging (MRI) starting Dec. 24. The scope of application will then be expanded in stages. Linked with medical institutions' electronic medical records, it will allow immediate access to necessary information during diagnosis and prescribing.
The burden of health insurance premiums for workplace subscribers will also be partially eased. Starting in Oct., if additional premiums to be paid due to year-end settlement and other reasons exceed a certain amount, they can be paid in installments for up to 12 months.
Currently, to apply for installment payment, the additional premium must be at least as much as the employee's share of the monthly remuneration-based premium. Going forward, if the additional premium is at least the minimum premium amount, an application can be made. Based on 2026, it will be possible for amounts of 10,080 won or more.
The reporting deadline for year-end premium settlement at establishments will also be extended. The deadline for establishments to submit data to the National Health Insurance Service will be extended from Mar. 10 to Mar. 31 each year.
Although more subscribers can settle premiums by linking with National Tax Service data, previously there was not enough time to review the data, so many establishments separately reported total remuneration. By extending the deadline to the end of Mar., the procedure has been changed to use National Tax Service data first and allow establishments to check and supplement only what is needed.
The criteria for managing covered and noncovered services under health insurance will also be adjusted. Even if a medical service or treatment material is already notified as covered or noncovered, grounds for ex officio adjustment will be clarified so that it can be re-reviewed if safety, effectiveness, or cost-effectiveness changes.
It will also be clearly stipulated in the law that pharmaceuticals with marketing authorization that have not been designated as covered by health insurance are noncovered items. This is not a measure to newly convert existing drugs to noncovered status; it is to reduce interpretive confusion in the law that arose during the reporting and disclosure of noncovered medical costs.