Out-of-pocket cap system refund amount of 50.6 billion won unpaid over 3 years… Average 790,000 won per person

(Seoul = Yonhap News) Reporter Seongho Seong = Among the refunds under the out-of-pocket cap system, which refunds excessive hospital expenses incurred by individuals, the amount that has not been paid over the past three years has been found to have reached 50.6 billion won.

According to data received from the National Health Insurance Corporation by So Byeong-hoon, a member of the National Assembly's Health and Welfare Committee, from the National Health Insurance Corporation on the 23rd, the amount that has not been paid due to the statute of limitations among the amount exceeding the out-of-pocket limit that was decided to be paid for 2020 to 2022 is a total of 50.597 billion won as of the 9th of this month. Since the total number of people involved was 63,994, approximately 790,000 won per person was not returned.

The out-of-pocket cap system is a system in which, in order to reduce the burden of household medical expenses, if the partial out-of-pocket expenses paid by a health insurance subscriber for one year (medical expenses paid by the patient, excluding non-coverage, selective benefits, etc.) exceed the individual out-of-pocket cap (890,000 to 10.74 million won as of last year), the National Health Insurance Corporation pays the excess amount and returns it to the subscriber and dependents.

After 2023, the statute of limitations has not yet reached the limit for excess amounts. Even though payment was decided from 2023 to this year, the amount in excess of the out-of-pocket limit that has not yet been returned amounted to 332.249 billion won (368,577 people).

Looking at the reasons for non-payment of excess money, 98.1% of the total amount, or 325.787 billion won, was found to be 'encouraging application.' Payment was not made because the payment application process was not completed properly.

There were also significant long-term unpaid bills; as of the 9th of this month, there were 56,276 people whose statute of limitations remained in three months or less, and the amount was 48.197 billion won.

After sending out the first payment application notice, the National Health Insurance Corporation notifies non-applicants again three months later, and sends a third notice three months before the expiration of the statute of limitations. The corporation explains that it also provides regular guidance through landlines, text messages, and notification messages.

Rep. So Byeong-hoon emphasized, "If the Corporation failed to lead to actual payment even after repeatedly sending notices and text messages, it is difficult to say that the Corporation has fulfilled its responsibility." He added, "The Corporation should actively contact those whose statute of limitations is nearing completion by phone and text, provide separate application support to the elderly and the disabled, and of course, in the long run, come up with a plan to provide refunds even without a separate application."