NHIC was established to provide people with health insurance benefits required to prevent, diagnose and treat diseases or injuries for their rehabilitation or provide against childbirth or death, all of which would contribute to the enhancement of their health and social security, and reasonably and efficiently execute services pursuant to the National Health Insurance Act and the Enforcement Decree of the same act.
Key services
| Service category |
Scope of services |
| Entitlement management |
- Addressing the occurrence/adjustment/termination of entitlement to workplace-based coverage
- Addressing the occurrence/adjustment/termination of insured status
|
| Billing management |
- Adjusting or reducing workplace-based &non-workplace-based premiums
- Settling premiums &adjusting monthly average wages used as a base to assess premiums
|
| Benefit management |
- Managing the payment of cash benefits
- Reimbursing co-payments overburdened on a beneficiary
- Rental services for the disabled (e.g. prosthetic appliance)
- Issuing written details about nursing benefits & medical examination
- Following up benefits paid & monitoring factors causing injuries
- Management of other collectibles
|
| Health care |
- Health diagnosis services
- Providing health services & information
- Supports for medical services
|
| Long-term nursing care for the aged |
- Eligibility management, supports for relevant services, resource management, etc.
- Determining eligibility for & paying nursing care benefits
- Following up nursing care benefits paid & managing resources
- Managing family nursing care benefits
|
| Collection management |
- Billing/collecting social insurance premiums & managing social insurance premiums in arrears
- Serving to the insured a statement to remind premiums whose due date is very imminent or premiums in arrears & managing places of service
- Reimbursing overpaid or mispaid premiums
- Disposition for recovery of premiums in arrears, as through foreclosure
Exceptions : Lump-sum premium reimbursements returned & retroactive premiums (NP) and construction & lumbering business (WC)
Lump-sum premium reimbursements returned refers to the repayment of the lump-sum amount of paid premiums reimbursed with a certain amount of interests to a beneficiary who couldn’t pay premiums anymore due to, for example, emigration although he/she hasn’t paid his/her due premiums for the required period. This would enable the beneficiary to continue to be insured by the NP scheme.
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