[123RF]
[123RF]

More than 360 billion won ($250 million) in medical cost refunds eligible under the national health insurance out-of-pocket cap system went unclaimed over the past five and a half years because patients never applied to receive them, new data shows.

Of that total, 37.8 billion won has been permanently forfeited after the three-year statute of limitations expired.

The figures come from data that People Power Party lawmaker Han Ji-a, a member of the National Assembly's Health and Welfare Committee, obtained from the National Health Insurance Service on Monday. From 2021 through June this year, a total of 424,727 refund cases worth 361.72 billion won went unpaid.

Under the out-of-pocket cap system, when a patient's annual insurance-covered medical expenses — excluding non-covered items — exceed an individually set government threshold, the National Health Insurance Service reimburses the difference.

Once the service notifies eligible patients, they must apply for the refund themselves. Any unclaimed amount lapses after three years. Notifications are typically sent each August for the previous year's medical expenses, after which the reimbursement process begins.

The annual breakdown of unclaimed refunds was as follows: 1,373 cases worth 1.33 billion won in 2021; 1,370 cases worth 1.75 billion won in 2022; 68,852 cases worth 55.03 billion won in 2023; 116,620 cases worth 109.39 billion won in 2024; 188,571 cases worth 171.81 billion won in 2025; and 47,941 cases worth 22.41 billion won as of June this year.

As of Aug. 22, a total of 54,002 cases worth approximately 37.8 billion won had passed the three-year statute of limitations without a refund application being filed. That includes 24,871 cases worth 15.73 billion won from 2021 and 29,131 cases worth 22.12 billion won from 2022.

"The system must function as intended so that eligible patients can receive what they are rightfully owed under the out-of-pocket cap," Han said. "We need to strengthen outreach to eligible patients and improve the application process so people do not lose their refunds simply because they did not know to apply."


thlee@heraldcorp.com