Starting next year, the period for reducing out-of-pocket expenses for preterm infants’ outpatient care will be extended to a maximum of 5 years and 4 months, and the upper limit for rewards for reporting fraudulent health insurance claims will be increased to 3 billion KRW. The Ministry of Health and Welfare announced on the 16th that a partial amendment to the ‘National Health Insurance Act Enforcement Decree’ was approved at the Cabinet meeting.
This amendment aims to alleviate the medical expenses burden for preterm infants, prevent financial leakage in health insurance, and strengthen post-management of health check-ups to enhance public convenience. The period for reducing out-of-pocket expenses for preterm infants’ outpatient care will be extended and applied differently according to the gestational period. Previously, all preterm infants were granted the same reduction period of 5 years from birth, but now the period will be extended up to 5 years and 4 months, considering the gestational period at birth.
The reward system for reporting fraudulent health insurance claims will also be improved. The amended enforcement decree standardizes the criteria for calculating rewards regardless of the type of informant and raises the upper limit from 2 billion KRW to 3 billion KRW. This aims to encourage reporting of fraudulent claims and prevent financial leakage in health insurance, thereby enhancing the sustainability of the system.
The exemption period for out-of-pocket expenses for additional treatments and tests following general health check-up results will also be extended. Previously, the exemption was valid until January 31 of the following year after the health check-up, but now the exemption period will be extended by 2 months until March 31 of the following year to strengthen the connection between post-check-up treatment and management and enhance the convenience for examinees.