Patients must pay 30% of medical bills if they visit hospitals more than 365 times annually

The Ministry of Health and Welfare has announced the amendment to the enforcement decree and implementation rules of the Medical Benefits Act to manage the appropriate number of days for medical benefits. (Credit: Getty Images)

Starting this October, medical benefit recipients will be subject to a 30 percent co-payment if their annual outpatient visits exceed 365.

The Ministry of Health and Welfare has announced a legislative preview of the amendment to the enforcement decree and implementation rules of the Medical Benefits Act by July 15.

The amendment stipulates the grounds for differential out-of-pocket expenses for medical benefits as prescribed by the ministry's decree if necessary.

It also reorganized the co-payments for outpatient and pharmacy medical benefits to be proportional to the beneficiary's medical use, set a maximum co-payment per case to ease the cost burden on beneficiaries, and expanded medical benefits by exempting patients with severe dementia and schizophrenia from co-payments.

As a result, Class 1 beneficiaries will pay 50 percent of the excess if the monthly deductible is more than 20,000 won ($14.7) but less than 50,000 won and 100 percent of the excess amount if the monthly deductible exceeds 50,000 won.

Class 2 beneficiaries shall pay 50 percent of the excess amount if the monthly deductible exceeds 200,000 won and 100 percent if the annual deductible exceeds 800,000 won. However, if a person is hospitalized in a nursing hospital for more than 240 days per year, the threshold will be increased to 1.2 million won annually.

The amendments aim to expand beneficiaries' options for medical care by abolishing the current upper limit on the number of days of benefits, extension approval, and the optional medical benefit organization system and strengthening national and local government responsibilities for proper management of the number of days of benefits.

However, the bill also includes a sliding scale for out-of-pocket expenses if the number of outpatient visits per year exceeds 365.

Accordingly, if the number of outpatient visits per year exceeds 365, the beneficiary will be required to pay 30 percent of the total cost of medical benefits for outpatient visits. The beneficiary will be notified if the number of outpatient visits exceeds 180, 240, or 300 days.

The amendments will be enforced this October after the legislative preview.