Copay Ceiling Refund Calculator

Copay Ceiling Refund Calculator helps estimate Korea-related medical expense, copay, refund, special-case, and uncovered-cost assumptions in English.

Out-of-pocket ceiling inputs

Ceiling refund result

Applicable ceiling

₩3,260,000

Income decile 6

Excess over ceiling

₩1,740,000

Covered copay only, non-covered excluded

Estimated refund

₩1,740,000

Expected payment year 2027

Remaining to ceiling

₩0

34.8% savings rate

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Korean out-of-pocket ceiling refund calculator

This page translates the Korean guide for the NHIS out-of-pocket ceiling refund. It estimates the post-year refund when covered copays exceed the income-decile ceiling.

What counts toward the ceiling

Only Korean National Health Insurance covered copays count toward the annual ceiling. Non-covered treatment, optional private room charges, caregiver costs, and other excluded items are not ceiling-eligible. The input should therefore be the annual covered copay from January 1 through December 31, not the total hospital bill.

The refund is calculated as covered copay minus the applicable ceiling, then minus any amount already received through advance benefit or earlier refund. If the covered copay is below the ceiling, the result shows how much more covered copay would be needed before a refund begins.

Treatment year and payment year

The Korean source distinguishes treatment year from payment year. The ceiling is applied to the treatment year, but the post-year refund is generally paid in the following year after NHIS finalizes annual expenses. The calculator returns payment year as treatment year plus one.

For example, a 2026 treatment-year refund is expected in 2027. This timing matters for cash-flow planning because a patient can still need to pay the bill first even if a refund is likely later.

Income decile and long-stay adjustment

Income decile runs from 1 to 10, where decile 1 is the lowest income group and decile 10 is the highest. Lower deciles have lower annual ceilings, so the same medical cost can create a larger refund for a lower decile.

The calculator also keeps the special long-term care hospital flag for stays over 120 days. When that flag is selected, a separate long-stay ceiling table is used by the Korean source function.

Practical checklist

Before using the result, collect the NHIS covered copay amount from statements or NHIS records. Exclude non-covered charges. Enter any advance benefit or already-refunded amount so the result does not double count.

The result is a planning estimate. Final refund eligibility is determined by NHIS data, treatment-year aggregation, income-decile classification, and excluded item rules.