How Korea's Copayment Special Case Is Set for Rare and Severe Illness

In Korea, the copayment special case — known in Korean as sanjeong teungnye — is a National Health Insurance rule that lowers the share of covered medical costs a patient pays, generally to between 0 and 10 percent, for designated severe, rare, and intractable illnesses once the condition is confirmed and the patient is registered. It sits on top of the ordinary co-payment system rather than being a separate program, and its scope is fixed across the National Health Insurance Act, its Enforcement Decree, and a Ministry of Health and Welfare notice. This article outlines the legal basis, the disease groups it covers, the co-payment rates and periods, the registration procedure, and how the rule is described as applying to foreign residents enrolled in the insurance.

What system the copayment special case comes from

The copayment special case is understood against the co-payment structure of National Health Insurance. Article 44(1) of the National Health Insurance Act provides that a person receiving health-care benefits pays part of the cost — the co-payment — as prescribed by Presidential Decree. Acting on that delegation, Article 19(1) of the Enforcement Decree fixes co-payment rates and amounts in its Table 2, and Table 2 in turn creates special cases that lower the co-payment for certain severe and rare illnesses, delegating the specific scope to a notice of the Minister of Health and Welfare. That notice is the Standards for Special Cases of Co-Payment. The version issued on April 29, 2026 and taking effect on May 1, 2026 — Ministry of Health and Welfare Notice No. 2026-101 — states that its purpose is to set the matters delegated in respect of the co-payment under Article 19(1) of the Enforcement Decree, which shows how the special case is built across the levels of statute, decree, and notice. The name itself reflects that the co-payment is calculated on a different basis from the general rule. The same co-payment structure under Article 44 also underlies the co-payment ceiling, a separate mechanism that caps a subscriber's total annual co-payments by income bracket, so the two operate on the same base but through different methods — one lowering the rate for a registered condition, the other refunding amounts above an annual limit.

Which disease groups the special case is divided into

The special case applies not to a single disease but to several disease groups defined separately in the notice. The notice broadly separates patients with severe illness; patients with rare disease and severe intractable disease; and patients with tuberculosis and latent tuberculosis infection, defining each group's scope in its own appended table. Article 4 of the notice sets the severe-illness group in Table 3, which is described as including cancer patients and patients with cerebrovascular disease, heart disease, and severe burns. Article 5 sets rare disease and severe intractable disease in Tables 4 and 4-2 respectively, and Article 5-3 defines severe intractable disease as a condition that can be treated but is hard to cure, requires continuous treatment, and would lead to death or serious disability if treatment stopped. Tuberculosis patients and those with latent tuberculosis infection are placed in a separate category by Article 5-2. Because each group has its own listed criteria, whether a particular condition falls within a group is treated as something confirmed against the disease-specific standards in the notice. The phrase "severe-illness special case" is common in everyday usage, but the rules are described as breaking the groups down and setting different standards for each.

How the copayment rate is set by disease group

When the special case applies, the patient's co-payment falls well below that for ordinary care. Under Ministry of Health and Welfare Notice No. 2026-101, Article 4 sets the severe-illness co-payment at 5 percent of the total covered cost, Article 5 sets the rare-disease and severe-intractable-disease co-payment at 10 percent, and Article 5-2 provides that the relevant tuberculosis care carries no co-payment. The applicable period also differs by group.

The periods differ by group; Table 3, for instance, treats a registered cancer patient as covered for five years from the date of registration for care relating to the registered condition. These rates and periods, however, attach to care for the registered condition to which the special case applies, and which costs the special case actually covers is described as depending on the treatment provided and the scope of the registered condition.

How registration criteria and the application procedure are set

Access to the special case is premised on registration. Article 7(1) of the notice provides that a person seeking to register as falling within the special case submits a health-insurance special-case registration form, verified by a health-care institution, to the National Health Insurance Service or the institution, and that the date of application is the date the form reaches the Service. Having the institution verify the form reflects that registration presupposes a confirmed diagnosis of the condition. On timing, Article 7(3) provides that an application made within 30 days of the date the diagnosis is confirmed is applied retroactively to the confirmation date, while an application made after 30 days applies from the date of the application. Article 7(6) provides that the Service supplies the disease-specific criteria to the applicant and the institution, who confirm that the criteria are met before applying. Whether the registration criteria are met is thus treated as something determined through the disease-specific standards in the notice and the institution's confirmed diagnosis. Confirming a diagnosis is generally described as resting on a combination of tests and clinical assessment rather than a single figure, and registration for the special case is understood to build on that confirmation.

What happens when the period ends: re-registration and termination

The special case does not apply indefinitely once registered; each disease group has a set period. As noted, a registered cancer patient's period is set at five years from registration, with the appended tables fixing periods by disease, so that the special case ends when the period runs out. Article 8 of the notice allows a person to apply to re-register at the end of the period where certain conditions are met — for a registered cancer patient, where residual or metastatic cancer or a further recurrence is confirmed and anticancer treatment is under way, or, for rare-disease and severe-intractable-disease patients, where the condition remains at the end of the period and treatment continues. Conversely, Article 7(10) treats cure, completion of treatment, transfer to another institution, death, or a change of diagnosis as grounds on which the special case ends. Because registration, application, termination, and re-registration are each defined by their own conditions, which stage an individual case is at is described as a matter to be confirmed through care and the Service's review.

How the special case applies to foreign residents enrolled in National Health Insurance

Because the special case operates within the co-payment rules of National Health Insurance rather than as a separate, nationality-based benefit, its reach follows enrollment in the insurance. The National Health Insurance Service states, in its English guidance for foreigners, that a foreigner or overseas Korean who has stayed in Korea for more than six months has been subject to mandatory subscription to health insurance since July 16, 2019, and that National Health Insurance for foreigners "has the same coverage as it does for the Korean citizens." On that basis, the copayment special case — being part of the shared benefit framework rather than a benefit tied to nationality — is described as applying to a foreign subscriber whose condition and registration meet the notice's criteria on the same terms that apply to a national.

The mechanics are described as the same for everyone: the special case attaches to the co-payment that a covered person pays under Article 44 of the National Health Insurance Act, registration runs through a health-care institution's verified form and the Service's confirmation, and the disease-specific standards in the notice apply without reference to nationality. Points that turn on individual circumstances — such as the visa or enrollment status under which a person is covered, or whether a given condition meets a listed standard — are treated as matters confirmed through enrollment records, care, and the Service's review rather than settled by residency alone.

Key points

Korea's copayment special case sits on the co-payment system of Article 44 of the National Health Insurance Act and, through Table 2 of Article 19 of the Enforcement Decree and a Ministry of Health and Welfare notice, lowers a patient's co-payment for designated severe, rare, and intractable illnesses. The scope is divided into groups — severe illness; rare disease and severe intractable disease; and tuberculosis and latent tuberculosis infection — each defined in an appended table, with the co-payment set at 5 percent for severe illness, 10 percent for rare and severe intractable disease, and none for the relevant tuberculosis care. Registration runs through a health-care institution's verified form submitted to the National Health Insurance Service, and an application made within 30 days of a confirmed diagnosis is applied retroactively to that date. Whether a condition falls within a group, and whether the registration criteria are met, is described as determined through the disease-specific standards in the notice, the institution's confirmed diagnosis, and the Service's review — so that a specific case is treated as an individual matter decided in the course of care.