What happened?

The number of people who did not claim refunds under South Korea's out-of-pocket medical cost cap nearly doubled between 2020 and 2022. Data from the National Health Insurance Service, released on October 16 by Democratic Party lawmaker Park Yong-gap, showed that cases whose refunds expired after the three-year limit rose from 15,759 to 29,126, an increase of 84.8%. The unclaimed amount grew from 12.73 billion won to 22.12 billion won over the same period.

How does the refund system work?

The out-of-pocket maximum system covers the amount a person pays in a year for non-covered and selectively covered treatments beyond a personal cap. Based on last year's rules, the cap ranges from 890,000 to 10.74 million won. Anything above the cap is refunded by the National Health Insurance Service.

Who is missing out?

The unclaimed cases are concentrated among lower-income people. Households in income deciles 1 to 3 made up 64.2% of unclaimed cases in 2022, up from 56.7% in 2020. Older adults are also heavily affected: 73.8% of expired cases in 2022 involved people aged 60 or older.

Why are refunds not being claimed?

The National Health Insurance Service offers an account consent option, under which people who tick the designated box receive payments automatically. However, the first notice is sent through a mobile platform, and those who do not open electronic documents receive a letter by mail. Park said people who struggle with online services, as well as day laborers whose residence is unstable, may be missed.

Separate findings on high-debt delinquent subscribers

The data also showed that high-debt, long-term delinquent subscribers who received refunds increased sharply. Those owing more than 10 million won and 13 months or more in arrears rose from 397 people in 2021 to 559 last year. From 2021 through June 2026, 2,426 such subscribers received refunds totaling 2.24 billion won.

For international fans

This story is mainly about South Korea's public health insurance system. Foreign residents who are enrolled in National Health Insurance may want to check their refund status through the National Health Insurance Service directly, since notices can arrive by mail or electronic document.