How health insurance works in Korea: the NHIS System Explained (2026)

Understanding how health insurance works in Korea starts with one fact: the country runs a single public insurance program, and joining it is required by the law. The Ministry of Health and Welfare supervises the program, and the National Health Insurance Service (NHIS) acts as the single insurer for everyone covered.

This guide explains how health insurance works in Korea from the top down: who is eligible, how the insured are divided into groups, what the insurance pays for, and the hospital rules that decide whether your visit is covered or billed to you in full.

At a glance

Item	Details
Who it covers	All citizens who reside in Korea, except Medical Aid Beneficiaries and Health Care Beneficiaries for veterans
Who runs it	The National Health Insurance Service (NHIS), a single non-profit insurer, supervised by the Ministry of Health and Welfare
Is it optional	No. Subscription is compulsory by the law, and so is collection of contributions
Types of the insured	The employee insured, the self-employed insured, and dependents of the employee insured
How contributions are set	By the level of the household’s income and property, paid monthly
What you receive	Equal insurance benefits, as benefits in kind and benefits in cash
Hospital rule	Two phases of care benefit; a referral slip is needed for a tertiary general hospital
Cost	Depends on your household’s income and property, so check the current amount on the official page

How health insurance works in Korea: one insurer for everyone

Korea runs one national health insurance program rather than a market of competing plans. The Ministry of Health and Welfare supervises the operation of the program through making and implementing policies. The National Health Insurance Service is a single insurer, and as a non-profit institution it provides health insurance to all citizens living in Korea.

The stated objectives explain why the program is built this way. It aims to resolve the medical expense problem and to protect public health and household budgets. It also redistributes income and disperses risk, with the goal of strengthening social solidarity and promoting social integration.

That idea of solidarity is described as the function and role of the program: health care expenses are shared reasonably, and insurance benefits are provided equally. Enrolment is not a choice you make. All Koreans except those belonging to the lower-income group enroll to the compulsory health insurance, all enrollees should pay the contributions monthly, and the collection of contributions is also compulsory.

The main features of the program

Compulsory insurance: subscription is compulsory by the law.
Short-term insurance: an increase in annual financial balance and short-term payment.
Contribution payment according to the level of the household’s income and property.
Equal insurance benefits for the insured.
Compulsory collection of contribution.

Contributions follow the level of your household’s income and property, but insurance benefits are equal. Two people paying different monthly amounts receive the same benefit coverage. Your contribution depends on your own household, so check the current figures on the official page instead of comparing with a colleague.

Organisation	Role in the system
Ministry of Health and Welfare	Supervises the NHI program by making and implementing policies
National Health Insurance Service (NHIS)	The single insurer: manages the eligibility of the insured, collects contributions, makes the medical service fee contract with representatives of health care providers, and provides benefits
Health Insurance Review & Assessment Service (HIRA)	Evaluates the medical service fee, the quality of health care, and the adequacy of medical service

⚠️ Healthcare providers may not refuse to treat NHI patients.

Who is covered and who counts as a dependent

Eligibility is broad. It covers all citizens who reside in Korea, except Medical Aid Beneficiaries and Health Care Beneficiaries for veterans. Those two groups are excluded from national health insurance eligibility. Medical Aid itself is listed inside the social security system under public assistance, together with Basic Livelihood Protection.

The insured are divided into two types, and a third group, dependents, is covered through a person who is employee insured.

The employee insured: the workers and employers in all workplaces, public officials and private school employees, and daily-paid workers at construction sites.
The self-employed insured: the insured other than the employee insured and their dependants, such as farmers and fishermen and self-employed persons.
Dependents: persons who are dependent for their livelihood on the employee insured and do not have other remuneration or income.

If you are an employee, some family members may be covered as your dependents instead of enrolling on their own. The qualifying relationships are given as examples, for example spouses, lineal ascendants, lineal descendants, and brothers or sisters of the employee insured. The criteria under Article 5, Enforcement Rule 2 must also be met.

Spouses of the employee insured.
Lineal ascendants of the employee insured, including lineal ascendants of their spouses.
Lineal descendants of the employee insured, including lineal descendants of their spouses, and the spouses of those descendants.
Brothers and sisters of the employee insured.

Most people in Korea are covered as employee insured or as their dependents. The figures below are the official population coverage as of April 2024.

Group (as of 2024.4)	People	Share
The employee insured	36 million	68.5%
Of which, dependents are included	17 million	33%
The self-employed insured	15 million	28.5%
Medical Aid	1.5 million	3%

⚠️ Contribution payment is according to the level of the household’s income and property, so check the current amount on the official page.

What the insurance pays for and where it sits in social security

Health insurance benefits have two kinds. Benefits in kind are the services you receive, and benefits in cash are amounts paid to you in specific situations.

Benefits in kind: health care benefit and health checkup.
Benefits in cash: leasing or purchase of assistive equipment cost for the disabled; reimbursement based on the co-payment ceiling system; and the cost given when a childbirth takes place at home or in a place other than a hospital.

The coverage is described broadly as healthcare service cost, including preventative treatment, diagnosis, treatment, rehabilitation, injuries, childbirth and death. The NHIS makes the medical service fee contract with representatives of health care providers, and HIRA evaluates the medical service fee, the quality of health care, and the adequacy of medical service. Before a large medical expense, check your own case on the official page.

Health insurance is also one piece of a larger structure. The social security system of Korea has three components: social insurance, public assistance, and social welfare service. Health insurance belongs to social insurance, which has five schemes: Health Insurance and Long-Term Care Insurance for the Elderly, National Pension, Unemployment Insurance, and Industrial Accident Compensation Insurance.

Seeing the whole map helps you understand how health insurance works in Korea when something goes wrong at work or at home. Health insurance secures medical treatment and promotes health, pension and unemployment insurance secure income, and industrial accident compensation insurance secures both. A work injury or a job loss has its own scheme, so the office that answers your question may not be the one that handles your medical bills.

The other schemes have their own named benefits. Industrial accident compensation insurance provides care benefit, temporary incapacity benefit, disability benefit, nursing benefit, survivor benefit, funeral expenses reimbursement, and injury and disease compensation pension. Employment insurance provides unemployment benefit and maternity and parental benefits, while long-term care insurance provides home-based and institution-based benefits for senior citizens who have difficulty in daily living due to geriatric diseases or cerebrovascular disease.

How health insurance works in Korea at a clinic or hospital

Korea uses a health care delivery system that decides where you should go first. It exists to utilise medical resources efficiently, to limit patients’ herd behaviour of seeking tertiary hospital services, to establish the roles of medical institutions, and to help curb the rise in national medical expenditures and secure financial sustainability.

Health care benefits are delivered by two phases. The 1st phase of care benefit means the benefit from health care institutions such as a clinic, a hospital, and a general hospital, except tertiary hospitals, which are also called specialized general hospitals. The 2nd phase means the benefit from tertiary hospitals.

Go first to a 1st phase institution: a clinic, a hospital, or a general hospital.
If more specialised care is needed, the doctor who saw you first decides and issues a referral slip. The slip must include the fact that the benefit beneficiary needs the 2nd phase of care benefit from a tertiary general hospital.
Present that referral slip at the tertiary general hospital to receive the 2nd phase of care benefit.

⚠️ When you receive medical treatment against the care delivery process, you must pay the entire care benefit expense, a co-payment of 100% of total expenses, pursuant to Article 10 of the enforcement regulations of the National Health Insurance Act.

You cannot request a referral slip as a formality. Issuing a doctor’s referral slip at a patient’s request is never allowed, because it is against the primary purpose of the health care delivery system. The decision belongs to the doctor at the first primary care institution.

Exceptions to the referral system

Patients with severe conditions under ‘Emergency medical treatment Article 2-1’.
Childbirth in the tertiary hospital.
Dental health care benefit.
Care at the department of rehabilitation and medical treatment for a disabled person under Article 32 of ‘the disabled’s welfare law’, or for a person acknowledged to need rehabilitation treatments such as vocational treatment or kinesiatrics, not simple physical therapy.
Health care benefit at the department of family medicine.
Patients who are employees of the tertiary hospital.
Hemophiliac patients receiving health care benefits in the tertiary hospital.

Tertiary general hospitals are designated by area, and Seoul has 14 upper-level general hospitals. Other areas, including Gyeonggi, Gangwon, Chungbuk, Chungnam, Cheonbuk, Cheonnam, Gyeongbuk and Gyeongnam, have their own designated lists. If you are unsure whether a hospital is a tertiary general hospital, check the official page first, because the answer changes whether you need a referral slip.

Common mistakes and what depends on your case

The most expensive mistake is going straight to a tertiary general hospital without a referral slip when no exception applies. You then pay 100% of the total expenses yourself.

Treating a large well-known hospital as the first stop. A clinic, a hospital, or a general hospital comes first.
Asking a doctor for a referral slip as a favour. Issuing a slip at a patient’s request is never allowed.
Expecting your contribution to match a friend’s. It follows the level of the household’s income and property.
Assuming a family member is automatically your dependent. The listed relationships are examples, and the criteria under Article 5, Enforcement Rule 2 must also be met.
Treating enrolment as the end of it. All enrollees should pay the contributions monthly.

What applies to you also depends on your group. Dependents are covered through a person who is employee insured, and they are described as persons who depend on that person for their livelihood and do not have other remuneration or income. Check on the official page which of your family members can be covered through you, rather than assuming.

⚠️ Health insurance in Korea is described as short-term insurance, with an increase in annual financial balance and short-term payment, so always confirm current conditions on the official page.

Frequently asked questions

Is health insurance in Korea compulsory?

Yes. Subscription is compulsory by the law, and the collection of contributions is also compulsory. All Koreans except those belonging to the lower-income group enroll to the compulsory health insurance, and all enrollees should pay the contributions monthly.

How much is the monthly health insurance contribution?

There is no single figure. Contribution payment is according to the level of the household’s income and property, so the amount depends on your situation. Check the current amount on the official page before you budget.

Can a hospital refuse to treat me if I use national health insurance?

Healthcare providers may not refuse to treat NHI patients. The NHIS manages the eligibility of the insured, collects contributions, and provides health insurance benefits, while HIRA evaluates the medical service fee, the quality of health care, and the adequacy of medical service. For your own situation, check the official page.

Do I need a referral slip to go to a big university hospital?

For the 2nd phase of care benefit at a tertiary general hospital, you must present a referral slip issued by the doctor who saw you first, stating that you need the 2nd phase of care benefit. Exceptions include severe conditions under ‘Emergency medical treatment Article 2-1’, childbirth, dental health care benefit, family medicine, listed rehabilitation cases, hospital employees, and hemophiliac patients. Without a slip and without an exception, you pay 100% of total expenses.

How does health insurance relate to pension and unemployment insurance?

Knowing how health insurance works in Korea also means knowing it is one of the five social insurance schemes, together with long-term care insurance for the elderly, national pension, unemployment insurance, and industrial accident compensation insurance. Health insurance secures medical treatment and promotes health, while pension and unemployment insurance secure income.

Now that you can see how health insurance works in Korea, take two practical steps: confirm which group you belong to — employee insured, self-employed insured, or dependent — and use a 1st phase institution before a tertiary general hospital. Contributions, designated tertiary hospitals, and benefit details can change, so confirm the current rules and your own case on the official pages listed below.

Last checked: November 3, 2026. Rules, fees and required documents in Korea change often, and some depend on your visa type and district office. Always confirm the current details on the official pages below before you go.