90% coinsurance rate for more than 300 outpatient visits a year — effective January 1, 2027; children, pregnant women and patients with severe illness excluded
Source material is a Korean government announcement (in Korean).
The Ministry of Health and Welfare (보건복지부) said a partial amendment to the Enforcement Decree of the National Health Insurance Act (국민건강보험법 시행령) was approved at the Cabinet meeting on September 8, 2026. Partial amendments to the Enforcement Rules of the National Health Insurance Act (국민건강보험법 시행규칙) and the Rules on the Standards for National Health Insurance Benefits (국민건강보험 요양급여의 기준에 관한 규칙) were promulgated the same day. From January 1, 2027, when the number of outpatient visits in a year exceeds 300, a coinsurance rate of 90% applies from the 301st visit. Children, pregnant women, people with severe disabilities among those covered by the special copayment program (산정특례), and patients being treated for severe, rare or severe intractable diseases are excluded from application, as at present. Even for those who do not fall under the exclusion criteria, the excessive medical use deliberation committee (과다의료이용심의위원회) of the National Health Insurance Service (국민건강보험공단) may review medical necessity and other factors and recognize an exception. A benefit use record checking system (요양급여내역 확인시스템), which lets medical institutions check a patient's use of health insurance benefits, will also be built. Building and operating the system is entrusted to the Health Insurance Review and Assessment Service (건강보험심사평가원); it applies first to CT and MRI from December 24, 2026, and expands to other items in stages thereafter. The criteria for workplace subscribers to apply for installment payment of additional premiums are also eased. From October 1, 2026, installment payment can be applied for even when the additional premium is at or above the lower limit of the monthly remuneration premium; based on the subscriber's own share in 2026, an application can be made when the additional premium is 10,080 won or more. Inquiries: Insurance Policy Division, Ministry of Health and Welfare (044-202-2702).
Key facts
| Approval | Cabinet meeting on September 8, 2026 — partial amendment to the Enforcement Decree of the National Health Insurance Act (국민건강보험법 시행령) |
|---|---|
| Application | From the 301st outpatient visit, starting January 1, 2027 |
| Coinsurance rate | 90% |
| Excluded | Children, pregnant women, people with severe disabilities among those covered by the special copayment program, and patients being treated for severe, rare or severe intractable diseases |
| Exceptions | The excessive medical use deliberation committee of the National Health Insurance Service may review medical necessity and other factors and recognize an exception |
| Benefit use record checking system | Applies first to CT and MRI from December 24, 2026 (entrusted to the Health Insurance Review and Assessment Service) |
| Installment payment of premiums | From October 1, 2026, an application can be made when the additional premium is 10,080 won or more (based on the subscriber's own share in 2026) |
| Inquiries | Insurance Policy Division, Ministry of Health and Welfare 044-202-2702 |
Last checked:
The Ministry of Health and Welfare (보건복지부) said a partial amendment to the Enforcement Decree of the National Health Insurance Act (국민건강보험법 시행령) was approved at the Cabinet meeting on September 8, 2026. From January 1, 2027, when the number of outpatient visits in a year exceeds 300, a coinsurance rate of 90% applies from the 301st visit. Children, pregnant women, people with severe disabilities among those covered by the special copayment program (산정특례), and patients being treated for severe, rare or severe intractable diseases are excluded from application, as at present.
Background — why this change
The number of outpatient visits per person a year in Korea was 17.9 in 2024, about 2.7 times the Organisation for Economic Co-operation and Development (OECD) average of 6.6. When a patient uses several medical institutions, each institution has difficulty checking treatment records from the others, and concerns have been raised about repetition of the same or similar treatment. The ministry explained that the amendment was prepared to guarantee necessary care while reducing repeated and duplicate treatment arising from excessive outpatient use. Separately, the period for workplaces to report to the National Health Insurance Service the data needed for year-end settlement of health insurance premiums is extended from March 10 each year to March 31, while the existing April premium settlement schedule is maintained.
Summaries below are factual notes based on government announcements and primary sources — not evaluations or opinions.
FAQ
Who is subject to the 90% coinsurance rate?
From January 1, 2027, it applies from the 301st outpatient visit when the number of outpatient visits in a year exceeds 300. Children, pregnant women, people with severe disabilities among those covered by the special copayment program, and patients being treated for severe, rare or severe intractable diseases are excluded from application, as at present.
Can an exception be recognized for someone not on the exclusion list?
Even for those who do not fall under the exclusion criteria, the excessive medical use deliberation committee of the National Health Insurance Service may review medical necessity and other factors and recognize an exception.
How many people actually exceed 300 visits a year?
Of about 48.4 million people who used outpatient care in 2025, 7,765 received treatment more than 300 times a year, and their annual average number of outpatient visits was about 344.7. A case of 1,775 outpatient visits in a year was also identified.