Foreigners, except Chinese nationals, contribute to surplus in Korea’s health insurance finances < Policy < Article

Foreigners, excluding Chinese nationals, enrolled in Korea’s health insurance system have consistently maintained a fiscal surplus in recent years, receiving less in benefits than they paid in premiums, government data showed on Monday.

According to data from the National Health Insurance Service (NHIS) obtained by Nam In-soon, a member of the National Assembly’s Health and Welfare Committee, foreigners, including Korean expatriates, paid a total of 2.69 trillion won ($1.94 billion) in premiums last year. Of the total premiums paid, 1.5 trillion won came from employer-sponsored health insurance, and 567.5 billion won from local-subscriber health insurance plans.

The total amount paid out in benefits to healthcare providers totaled 1.329 trillion won, resulting in a surplus of  740.3 billion ($535.4 million) for the NHIS.

This surplus trend has persisted since the mandatory enrollment of foreigners in July 2019, with consecutive annual surpluses: 373.6 billion won in 2019, 587.5 billion won in 2020, 525.1 billion won in 2021, 556 billion won in 2022, and 740.3 billion won in 2023.

Over the past five years, this cumulative surplus has reached 2.78 trillion won.

However, among the top 10 countries by number of foreign enrollment last year, Chinese nationals were the only group to cause a 64 billion won deficit for the NHIS.

In previous years, Chinese health insurance finances have recorded deficits of 98.7 billion won in 2019, 23.9 billion won deficit in 2020, 10.9 billion won deficit in 2021, 22.9 billion won deficit in 2022, and 64 billion won deficit in 2023.

Following the implementation of mandatory health insurance enrollment for foreigners in July 2019, the fiscal deficit for Chinese nationals initially shrank but has grown again since 2022.

According to NHIS, this growing deficit is attributed to a rise in the number of Chinese nationals enrolled in health insurance post-Covid-19. The enrollment numbers are estimated to have increased from 334,435 in 2021 to 355,472 in 2023, resulting in higher benefit payments and associated costs.

NHIS authorities have responded by implementing stricter standards for foreign enrollent and premiums, mandating enrollment as local subscribers and requiring full premium payments unless individuals are employed or have dependents , applicable to anyone holding a foreign passport residing in Korea for six months or more . 

Since 2019, premiums collected from foreign local subscribers have increased annually, totaling 270.5 billion won in 2019, 460.9 billion won  in 2020, 478.2 billion won in 2021, 504.6 billion won  in 2022, and 567.5 billion won in 2023.

Furthermore, as of April this year, foreigners and expats entering Korea must reside in the country for at least six months before becoming eligible to be dependents. This measure aims to prevent foreigners from entering Korea solely for medical treatment.

Previously, many foreigners registered as dependents of their employers immediately upon arrival and left the country after receiving medical treatment and surgery benefits.

However, spouses or minors under 19 with valid reasons for residence such as a student visa (D-2), student visas for elementary, middle, and high school international students (D-4-3), non-professional work visa (E-9), permanent residency visa (F-5), or marriage migrant visa (F-6), can immediately become dependents upon entering Korea.