Starting next year, the period for reducing the out-of-pocket burden for outpatient treatment of premature babies 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 the 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 premature babies, prevent leakage of health insurance finances, and strengthen post-management of health checkups to enhance public convenience. Previously, all premature babies were given the same out-of-pocket reduction for up to 5 years from birth, but now the reduction period will be extended up to 5 years and 4 months, considering the gestation 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 leakage of health insurance finances, thereby enhancing the sustainability of the system.
The exemption period for out-of-pocket expenses for additional treatments and tests following general health checkup results will also be extended. Previously, the exemption was until January 31 of the following year after the health checkup, but now the exemption period will be extended by 2 months to March 31 of the following year to strengthen the connection between health checkups and subsequent treatment and management, and to improve convenience for examinees.