The Out-of-Pocket Ceiling Refund Deadline Is Three Years, Not Five — 2025 Letters Go Out in Late August

What the late-August letter is about

The out-of-pocket ceiling system refunds the excess when the total co-payments you paid over one calendar year (1 January to 31 December) exceed your personal ceiling. The legal basis is Article 44(2) of the National Health Insurance Act.

Money paid across several hospitals can only be added up once the year has closed, so the reconciliation happens the following year and the Service notifies those affected. The letters going out this year cover treatment received between January and December 2025. As in previous years, they are sent in batches from late August.

There is not one ceiling but one per income bracket

The ceiling depends on your average annual insurance premium bracket, and splits again according to whether you spent more than 120 days as an inpatient at a long-term care hospital. These are the 2025 treatment-year figures.

Premium bracket	Standard	Over 120 days, long-term care hospital
1st decile	KRW 890,000	KRW 1,410,000
2nd-3rd	KRW 1,100,000	KRW 1,780,000
4th-5th	KRW 1,700,000	KRW 2,400,000
6th-7th	KRW 3,200,000	KRW 3,960,000
8th	KRW 4,370,000	KRW 5,690,000
9th	KRW 5,250,000	KRW 6,840,000
10th decile	KRW 8,260,000	KRW 10,740,000

The ceilings are adjusted each year in line with the consumer price index. For 2024 treatment the first decile was KRW 870,000 and the tenth KRW 8,080,000, so in a single year they rose by KRW 20,000 and KRW 180,000 respectively. Working from what the figure was last year will therefore give you the wrong answer.

Advance payment and later refund are two different things

If you stay in the same hospital and your co-payments pass the ceiling there, the hospital bills the Service directly for everything above it. That is the advance-payment route. You never pay the money, so there is nothing to reclaim afterwards.

Money split across several hospitals and pharmacies, by contrast, can only be tested against the ceiling once the year is totalled. That is the later refund route, and it is the one that needs the August letter and an application.

Not everything you paid gets counted

This is why the total on your receipts and the figure the Service calculates do not match. Article 19(3) of the Enforcement Decree lists what is left out of the tally. In practice these are the items that catch people:

• All non-covered items (private room supplements, manual therapy packages, cosmetic procedures and so on)
• Selective benefits and items charged entirely to the patient
• Room charges for two-bed and three-bed wards
• Chuna manual therapy
• Co-payments for outpatient visits to tertiary hospitals for mild conditions
• Items such as implants that carry their own separate co-payment rate

Even where insurance applies, an item with its own fixed co-payment rate — such as implants and dentures from age 65 — is excluded from the tally. If you spent a great deal on a serious illness and the excess still comes out small, the usual reason is that non-covered items made up a large share.

The deadline is three years, not five

Article 91(1) of the National Health Insurance Act sets the limitation period for the right to receive insurance benefits at three years (subparagraph 3 of that paragraph). The out-of-pocket excess is an insurance benefit, so it falls under that rule. Once three years pass, an eligible person can no longer collect.

Paragraph 2 of the same article covers interruption of the period. Claiming an insurance benefit interrupts the limitation period, so simply registering your account preserves the right. The most costly move is to put the letter in a drawer and let the year turn.

Applying means registering one bank account

You can use the Service website, the mobile app, Government24, the call centre on 1577-1000, a branch visit, fax or post. The procedure itself amounts to registering the account the money should be paid into.

One restriction matters: payment is made only to an account in your own name (Enforcement Decree Article 19(5)). A family member applying on your behalf needs a formal authorisation, and a parent's refund cannot be paid into a child's account. During the late-August to early-September rush, payment can take a few extra days.

No letter does not mean no entitlement

That conclusion does not follow. If your address changed or your contact details are out of date, the letter never arrives. The outline of the system and where to check it are set out in how to check health insurance refunds, so look it up yourself in the app or on the website even if nothing came.

If the year involved a long stay in a long-term care hospital, whether you crossed the 120-day line changes the ceiling substantially. Where admission type and care grading are both in play, it is worth reading how long-term care grading works as well. Unlike schemes where missing a notice brings a penalty, here there is no fine — the money simply disappears.

In short

Work through it in this order. First, watch for post and app messages from late August. Second, compare your bracket's 2025 ceiling with what you actually paid in co-payments. Third, check the app or website directly even if no letter came. Fourth, register an account in your own name if you qualify. Fifth, remember the limit is three years, and that claiming interrupts it.

This article explains the scheme and does not determine any individual's eligibility or amount. Confirm your own bracket and excess with the National Health Insurance Service on 1577-1000.