From the 2026 ceiling table to the application process, organized in the order of the most frequently asked questions. You can check your estimated refund in the calculator at the bottom.
The lower your income, the lower your ceiling, so you are more likely to be eligible for a refund even with smaller medical costs. Ceilings are divided into seven bands, and if you were hospitalized in a long-term care hospital for more than 120 days, a higher separate ceiling applies.
| Income decile | Standard ceiling | Long-term care hospital over 120 days |
|---|---|---|
| Decile 1 (lowest 10%) | ₩900,000 | ₩1,430,000 |
| Deciles 2–3 | ₩1,120,000 | ₩1,810,000 |
| Deciles 4–5 | ₩1,730,000 | ₩2,450,000 |
| Deciles 6–7 | ₩3,260,000 | ₩4,040,000 |
| Decile 8 | ₩4,460,000 | ₩5,800,000 |
| Decile 9 | ₩5,360,000 | ₩6,980,000 |
| Decile 10 (highest 10%) | ₩8,430,000 | ₩10,960,000 |
For example, if a person in decile 1 paid ₩2,500,000 in covered out-of-pocket copayments in 2026, the refund is ₩1,600,000 after subtracting the ₩900,000 ceiling. Conversely, if a person in decile 8 paid ₩4,000,000, they fall short of the ₩4,460,000 ceiling and are not eligible for a refund. Medical costs are totaled on an individual basis for the person who received treatment. Even spouses cannot combine each other's medical costs.
Not the full amount on your receipt — only the out-of-pocket copayments for covered items under National Health Insurance are included. The items below are excluded from the ceiling calculation no matter how much you paid.
The key is to add up only the amount in the "out-of-pocket copayment" column under "covered" on your hospital receipt. Large costs such as caregiving fees and premium room charges are mostly excluded items, so if you expect a refund based only on the total bill, the difference from the actual refund can be large.
The difference is when you get the money back. If a large amount arises at one hospital, it is settled on the spot through advance payment at hospital; if you paid in parts at several places, it is settled all at once the following year through a post-settlement refund.
If the annual out-of-pocket copayments you paid at the same hospital exceed that year's highest ceiling (₩8,430,000 in 2026), you pay only up to the ceiling and the hospital claims the excess directly from the NHIS. You do not need to apply separately. However, long-term care hospitals have been excluded from advance payment at hospital since 2020.
Amounts paid at multiple hospitals and pharmacies are added up over one year. Confirmation of income and premiums, which determines your personal ceiling, finishes around July of the following year, and notices and settlement begin around August. Amounts already received through advance payment at hospital are deducted from the refund.
Once you are confirmed as eligible, the NHIS sends a notice first. People who have registered a consent account for payment in advance receive the money automatically without applying; others can apply after receiving the notice.
Even if you did not receive a notice, you can check your eligibility and any unpaid amount directly on the website, in the app, or by phone. To receive payment into an account in another person's name, additional documents such as a power of attorney may be required.
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A post-settlement refund is settled around August of the year after treatment. For 2025 treatment, notices were sent from August 31, 2026, and people who had registered a consent account for payment received deposits in sequence from September 2. Advance payment at hospital is applied at the hospital at the time of treatment.
Your decile is determined by your household's average annual health insurance premium. You can check it by looking up your premium on the NHIS website or in its app, or by contacting 1577-1000. Once you are confirmed as eligible, the notice shows your personal ceiling.
No. Non-covered services, selectively covered services, amounts paid in full by the patient, implants, inpatient charges for premium rooms (2- or 3-bed rooms), and the patient share for chuna manual therapy are excluded. Add up only the covered out-of-pocket copayments on your receipts.
Yes. If you are hospitalized for more than 120 days in a year, a separate ceiling (₩1,430,000–₩10,960,000 in 2026) applies. Because the ceiling is higher, the threshold for a refund also rises, so an estimate calculated with the standard ceiling may differ from the actual refund.
You can check directly in the refund lookup menu on the NHIS website or in its app, or at 1577-1000. If your contact information changed or you missed an electronic document, checking directly is the surest way.
You cannot receive it after the 3-year statute of limitations expires. If you receive a notice, apply without delay, and if you register a consent account for payment, payments will be deposited automatically from next time without applying.
Sources: National Health Insurance Service (NHIS), "2026 Copayment Ceiling Amounts Notice" (January 6, 2026; applicable January 1–December 31, 2026); Ministry of Health and Welfare and NHIS press release, "Refund of ₩3.076 trillion in copayment ceiling excess amounts to 2.26 million people to ease medical cost burden" (August 2026); NHIS website guidance on the Copayment Ceiling System (Article 19 of the Enforcement Decree of the National Health Insurance Act). Verified: October 20, 2026. Whether you are eligible for a refund and the amount are subject to the final determination of the NHIS.