건강보험 가입제외 제도 안내

 


❍ 근거: 국민건강보험법제109조(외국인 등에 대한 특례) 제5항 제2호, 

법 제41조(요양급여) 제1항「가입자와 피부양자의 질병, 부상, 출산 등에 대하여 요양급여를 실시한다.」


❍ 대상:외국의 법령·외국의 보험·사용자와의 계약으로 건강보험에 준하는 의료보장

󰠚 외국의 법령: 프랑스(정부간 협정, 영주권자 제외), 일본(본국에서 의료비 보상), 미국·UN(정부관료‧군인과 퇴직자 및 그 가족 의료보장)

󰠚 외국의 보험: 본국 민간보험, 국내 체류 이전 가입, 보험료는 본인 부담

󰠚 사용자와 계약: 사용자가 근로자의 의료보험료 또는 의료비를 대납‧보상 


❍ 보험증서 인정기준

󰠚 외국의 보험: 재외국민 주민등록, 국내거소신고, 외국인등록 전 가입한 보험만 제외 인정, 외국계 회사라도 국내에서 출시된 보험 상품은 가입제외 불가

∙ 당연적용(‘19. 7. 16.) 이전에 가입한 외국 보험 인정

예시) [별첨] 자료 참고

󰠚 외국의 보험·사용자와의 계약: 보장금액·범위·수급 빈도 등에 제한이 없을 것(보장금액 10억 이상 등 보장범위가 상당히 큰 경우 제한 없는 것으로 간주)

∙ 여성의 경우 출산관련 의료보장 되어야 함(출산관련 보장내용 없을시 가입제외 불가)


❍ 제출 서류(원본과한글 번역본 포함) 한글 번역본 없을 경우 처리 불가

󰠚 공통: 자격상실신고서, 가입제외신청서, 의료보장을 받을 수 있음을 증명하는 서류

󰠚 외국의 보험: 외국보험 가입증서 등과 법 제41조에 따른 요양급여에 상당하는 의료보장을 받을 수 있음을 증명하는 서류

󰠚 사용자와의 계약: 근로계약서 및 사용자가 의료비를 지급한 사실을 증명하는 서류


❍ 가입제외 후 재가입

󰠚 외국 보험, 사용자 계약: 가입제외기간(최대 1년)이 경과 및 제외사유 해소된 날

󰠚 외국의 법령: 본인 신청 시 재가입 가능.(다만, 향후 같은 사유로 가입제외 불가)


[별첨] 외국의 보험 가입 내역 현황(한글 번역 대상 항목) 1부.

[별첨] 외국의 보험에 의한 건강보험 가입제외 신청 시 한글번역 참고용 서식

Reference form for application for exclusion of health insurance by foreign insurance


『외국의 보험』 가입 내역 현황(한글 번역 대상 항목)

Status of foreign insurance subscriptions(Items subject to Korean translation)


※ ①번 항목부터 ⑦번 항목까지 해당하는 내용을 한글로 번역하여 적어 주세요.

Please translate the contents of items ① to ⑦ into Korean and record them.


※ 보험가입 원본 서류에 아래 해당 항목 일련번호(①~⑦) 표기하여 첨부하시기 바랍니다.

Please indicate the above serial number(①~⑦) on the original insurance policy.


① 보험회사 정보

Insurance company

명칭(Name)

국가명(Country name)

② 피보험자 정보

Insured person

성명(Name)

생년월일(Date of birth)

③ 보장 기간

Guarantee period

시작일(Guaranteed start date)

종료일(End date of guarantee)

④ 보장 내용

Contents of 

medical coverage

※ 여성의 경우, 출산관련 의료보장 되어야 함.

For women, childbirth medical treatment should be guaranteed.

⑤ 보장 횟수 (Guaranteed number of times)

⑥ 보장 지역

Guaranteed area

⑦ 보장금액

Guaranteed amount

최대 의료 보장금액(Maximum medical coverage amount)

◎ 건강보험 가입 제외 인정 기준(Criteria for exclusion from health insurance coverage)

① 국내에서 출시된 보험은 제외 불가 (Insurance launched in Korea cannot be excluded)

② 피보험자 성명과 생년월일 표기 (There must be information on the insured's name and date of birth)

③ 외국인등록일 이전 보험가입 (Insurance subscription date must be before the foreigner registration date)

④ 일반적인 질병 부상에 대한 의료보장 (Medical coverage for common disease injuries should be provided)

⑤ 의료 보장 횟수에 제한이 없어야 함(There should be no restrictions on the number of guarantees)

⑥ 한국에서 의료보장을 받을 수 있어야 함(You need to be able to get health protection in Korea)

⑦ 의료보장 금액에 제한이 없어야 함(보장 금액이 최소 10억원 이상)

There should be no limit to the amount of medical coverage (at least a billion won)

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