Review the costs left after special-copay registration
A rare-disease diagnosis can leave patients and caregivers arranging both treatment and applications for financial assistance.
South Korea’s special-copay registration reduces the patient share of covered NHI care; rare-disease medical assistance is a separate program that considers economic burden.
Registration does not automatically enroll a patient in medical assistance: file with the relevant public health center and complete the disease and household checks.
This calculator helps prepare evidence and questions before that consultation.
It does not infer a diagnosis or issue an eligibility decision.
Use confirmed disease records, assessed household amounts and itemized patient charges to compare remaining costs under conditional approval and no approval.
That comparison can help plan payments while an application is reviewed.
The disease list and financial tables apply from 2026-01-01; evidence was checked on 2026-10-08.
Reform plans for 2027 onward are not applied early.
This English page explains the same Korean program and uses KRW, not another country’s benefit rules.
Match the disease name, KCD code and registration symbol
The 2026 assistance list contains 1,389 rare diseases and 24 transitional severe intractable diseases: 1,413 entries in total.
Search the documented name, Korean Classification of Diseases code or special-copay symbol, then select the exact entry.
Several diseases can share a code, so a code match alone does not confirm coverage.
For a condition without an assigned KCD code, match its exact name, specialist explanation and registration category.
- Confirm registration under the same category as the application condition: rare, ultra-rare, other chromosomal abnormality or severe intractable disease.
- Read restrictions such as the G12.28 exclusion for motor-neuron disease and congenital-only nephrotic-syndrome entries.
- Dialysis/disability conditions for chronic kidney disease and subtype restrictions for particular syndromes require supporting evidence.
- Search shows up to 30 matches; use a specific name or symbol to narrow results.
An additional-item flag in the list does not mean a particular patient qualifies for a device, rental, caregiving or dietary payment.
If the diagnosis is absent or the registered scope is unclear, ask the health center and specialist before treating the cost as eligible.
Confirm household membership and assessed amounts
Patient-household membership follows program guidance, rather than an informal count of people sharing expenses.
Separately registered parents, children and their spouses can fall within the supporter assessment; do not merge them into the patient’s household.
Use detailed family certificates and explain living/support arrangements to confirm membership, exclusions and exemptions.
The “no relevant household” choice requires confirmation with the authority.
Monthly assessed income
Use actual income before tax after deductions allowed by this program.
Take-home pay, NHI premiums and another welfare program’s income measure are not substitutes.
Check wage, business, property and transfer income records and applicable deductions.
Assessed total assets
Confirm property, lease deposits, financial assets, allowed debts and vehicle treatment.
A basic review structure is max(0, non-vehicle assets−approved debt)+assessed vehicle value.
Do not deduct leftover debt again from the vehicle; exclusions and valuation exceptions require evidence.
Leave an unknown value blank.
Zero means a confirmed absence, not missing information.
Even low numbers do not produce conditional support until the assessment confirmation is checked.
2026 monthly income: general limits of 140% / 200%
Ordinary patient households are compared with strictly below 140% of standard median income; supporter households use 200%.
Confirmed haemophilia, Gaucher disease, Fabry disease and mucopolysaccharidosis use the four-disease limits of 160% for patients and 240% for supporters.
A shared classification code does not automatically enable those higher limits.
The table shows monthly KRW, rounded to whole won in line with the official displayed figures.
2026 monthly income limits in KRW; equality with displayed income requires rounding-boundary review| Members | Patient 140% | Supporter 200% | Four-disease patient 160% | Four-disease supporter 240% |
|---|
| 1 | 3,589,933 | 5,128,476 | 4,102,781 | 6,154,171 |
| 2 | 5,879,009 | 8,398,584 | 6,718,867 | 10,078,301 |
| 3 | 7,502,650 | 10,718,072 | 8,574,458 | 12,861,686 |
| 4 | 9,092,633 | 12,989,476 | 10,391,581 | 15,587,371 |
| 5 | 10,579,407 | 15,113,438 | 12,090,750 | 18,136,126 |
| 6 | 11,978,333 | 17,111,904 | 13,689,523 | 20,534,285 |
| 7 | 13,321,210 | 19,030,300 | 15,224,240 | 22,836,360 |
For 8–15 members, add KRW 959,198 to the seven-person median for each additional member, then apply the relevant percentage.
Ask the health center about a household larger than 15 members.
The program uses a strict-below condition, but the income table displays rounded whole-won figures.
Income exactly equal to a displayed limit is withheld for boundary confirmation rather than automatically accepted or rejected.
A clearly higher amount is flagged for exception review, rather than treated as a final administrative denial.
Asset limits depend on region, household and disease category
The four regions are Seoul, Gyeonggi, metropolitan cities/Sejong/Changwon and other areas.
Limits differ between patient and supporter households and change with household size and the four-disease category.
Low income alone is insufficient if the asset requirement is not met.
These are general one-person examples; the calculator uses all official 1–15-person figures.
2026 general one-person asset limits, strictly below the amount in KRW| Region | Patient | Supporter |
|---|
| Seoul | 370,791,006 | 617,985,010 |
| Gyeonggi | 313,791,006 | 522,985,010 |
| Metropolitan cities / Sejong / Changwon | 304,791,006 | 507,985,010 |
| Other regions | 232,791,006 | 387,985,010 |
Assets exactly equal to the official integer limit fail the strict-below comparison.
This differs from the income rounding-boundary hold.
Do not infer eligibility from an estimated property price or an unconfirmed debt deduction.
Recheck amounts when valuation dates or recognized debt treatment change.
Supporter exemptions and special pathways need confirmation
For the ordinary 2026 pathway, add every relevant supporter household separately and compare its assessed income and assets.
If a household uses an assessment exemption, confirm the specific pathway and evidence; difficulty contacting a relative is not automatically an exemption.
A confirmed exempt supporter can have blank financial amounts, while an unchecked exemption keeps support withheld.
When the ordinary formula stops
Multiple patients in a household, haemophilia antibody/HIV/inpatient exceptions and patient-household assessment exemptions need individual review.
Medical Aid and reduced-copay recipients also use separate conditions for caregiving or dietary assistance.
The calculator shows a separate-pathway status rather than an ordinary award estimate.
Check next year’s rules
The phased supporter reform announced on 2026-09-03 concerns 2027 onward.
It does not automatically remove supporter assessment in this 2026 calculation.
If filing or reassessment crosses into a new year, check the enacted guidance, effective date and covered disease categories.
An exemption or higher limit can materially change a family’s review, but a short diagnosis label is insufficient evidence.
A withheld result means more confirmation is needed; it is not a finding that applying is impossible.
Use the listed issues as questions for the health center.
Record the actual application date
Medical assistance starts from the actual assistance-filing date.
After selection, eligible costs incurred from filing can be claimed retrospectively; earlier costs are not ordinarily covered retroactively.
Do not substitute a hospital’s special-copay registration date or the date of a telephone inquiry for filing.
Discuss the application route and required documents early to limit costs accumulating before filing.
- Contact the health center for the registered residence with diagnosis and registration records.
- Keep the filed application and dated receipts, separating pre-filing and post-filing charges.
- Plan payment cash while review normally takes 30 days, 60 days for special reasons, with further extensions possible.
- After selection, confirm claim handling and actual processing/deposit timing.
The calculator does not add 30 or 60 days to produce a guaranteed payment date.
Regular reassessment occurs every two years; this does not mean every patient’s support necessarily ends after exactly two years.
Report and confirm changes in household income/assets, residence or status.
Ordinary calculation requires both dates to be in 2026, with filing no later than the cost end date.
Six cost categories and coordinated compensation
Enter actual patient charges after special-copay benefits once, not the hospital’s total cost or the NHI share.
Allocate insurance payments, refunds and other assistance to their matching cost line.
Leave coordination unconfirmed until payment allocation and overlap treatment are established.
Compensation above its line’s charge is an error; it is not silently converted to a zero balance.
- Pre-application costs remain in the unsupported burden.
- Post-application eligible covered copay for the target disease is the ordinary medical-support candidate.
- Noncovered care is not automatically included in ordinary copay assistance.
- Full patient payment, 100/100, is recorded separately.
- Selective/provisional benefits and excluded rooms require billing classification.
- Other conditions, living costs and caregiving remain outside this ordinary medical-support calculation.
Formulas and interpretation
Net cost per line = patient charge−allocated other compensation.
Burden without support B = sum of the six net cost lines.
Conditional support S = post-filing eligible covered net copay, only after all required confirmations.
Conditional remaining burden = B−S.
Own-budget shortfall range = max(0, B−S−budget) ~ max(0, B−budget).
Under Article 12-2, publicly supported covered copays exceeding the annual copay cap can be refunded to the state/local authority.
Do not assume the patient also receives that refund and deduct it a second time.
Private-insurance coordination also requires the actual contract and payment records.
Fictional example: KRW 1.1–2.1 million remaining
Assume an ordinary NHI patient with multiple sclerosis, G35.0, has confirmed diagnosis, registration and household assessment and files on 2026-10-01.
Through 2026-10-08, patient charges are KRW 300,000 before filing, 1,200,000 eligible covered copay, 500,000 noncovered, 200,000 full patient payment, 100,000 selective/excluded and 100,000 other costs.
Allocate KRW 200,000 compensation to eligible covered care and 100,000 to noncovered care; all other compensation is confirmed zero.
Conditional support and remaining burden
KRW 2,400,000 charges−300,000 compensation = B 2,100,000.
KRW 1,200,000 eligible copay−200,000 matching compensation = S 1,000,000.
Remaining burden is KRW 1,100,000 under conditional approval and 2,100,000 without approval.
Own budget and shortfall
With KRW 800,000 available, the shortfall range is KRW 300,000–1,300,000.
This compares conditional approval with no approval; it does not promise an immediate reduction at the payment desk.
The fictional patient is a one-person Seoul household with monthly assessed income KRW 2,000,000 and assets 100,000,000.
The supporter is a two-person Gyeonggi household with income KRW 4,000,000 and assets 100,000,000.
All membership, assessed amounts and cost scope are assumed confirmed.
Replace them with your own confirmed records and check for blank values or withheld issues.
Keep caregiving, dietary and device applications separate
Additional-item flags can help prepare a second consultation list.
The 2026 list flags 101 diseases for assistive devices, 111 for ventilator/cough-assist rental, 105 for caregiving, 28 for special formula/low-protein rice and 9 for cornstarch.
These counts describe flagged diseases, not automatic payments to every registered patient.
Check the KRW 300,000 monthly caregiving amount, special formula up to KRW 3,600,000 annually, low-protein prepared rice up to KRW 1,680,000 annually and cornstarch up to KRW 1,680,000 annually.
Each has additional disease, age, disability, consumption/rental, documentation and claim-limit conditions.
These amounts are not automatically added to ordinary medical support S.
Three practical caregiver situations
- After initial diagnosis: separate special-copay registration from assistance filing and organize the application sequence.
- When costs rise during treatment: distinguish covered candidates from costs the family still needs to fund.
- When circumstances change or reassessment approaches: update income/assets and confirm all relevant households again.
Review TXT files contain private disease, household and financial information.
Inputs are calculated in the current page and are not sent to a server or automatically stored.
Keep downloaded files private and use only the necessary information for consultation.
When printing, retain unknown values, the rule year, evidence date and withheld reasons to avoid misunderstanding.
Frequently asked questions
Does special-copay registration automatically provide assistance?
No.
File a separate assistance application with the health center after confirming the same registration category and disease evidence.
Do not use the hospital registration date as the assistance-filing date.
Is household pay below 140% enough?
No.
Confirm assessed income, assets, household membership and supporter assessment or exemptions, as well as disease, registration and cost scope.
Low numbers alone do not release conditional support.
Are parents excluded if they live separately?
Not automatically.
Separately registered parents can be assessed as supporters.
Confirm relevant households and exemptions under this program’s guidance with the health center.
What if income equals the displayed limit?
Income equality is held for whole-won rounding-boundary confirmation.
Assets equal to the official integer limit are flagged as at/above the strict-below limit.
Do not change official figures to force a result.
Can costs before filing be reimbursed?
Ordinary support starts from the application date, so earlier costs are not included in the retrospective support candidate.
Ask separately about other programs and avoid deducting the same compensation twice.
Can I enter the entire receipt as eligible covered care?
No.
Classify actual post-special-copay patient charges into eligible covered, noncovered, full patient payment, selective/excluded and other costs.
Unrelated or excluded items are not ordinary support candidates.
Does a withheld or separate-pathway result mean I cannot apply?
No.
It means evidence or an exception needs confirmation.
Bring the reasons and review to the health center and discuss exemptions, additional items or other programs.
The authority makes the final decision.
Can I stop preparing cash after approval?
Payment timing and a budget estimate differ.
Excluded costs remain, and money may be needed before selection, claiming or settlement.
Do not treat the 30/60-day review guidance as a guaranteed deposit date.
Official evidence and application preparation
The Rare Disease Management Act covers financial assistance in Article 12, excess-copay refunds in Article 12-2 and financial-information consent in Article 13.
Checks also cover Enforcement Decree Article 8, Enforcement Rule Article 6, the rare-disease medical-assistance notice and the 2026 program guide.
Legal versions verified: Act MST266647 effective 2025-06-04; Decree MST281183 effective 2026-01-02; Rule MST266101 effective 2024-10-22; notice serial 2100000251944 effective 2025-01-01.
Take the next step
Prepare a diagnosis or specialist explanation, registration proof, detailed family certificates, income/assets declaration and financial consent, relevant lease/vehicle/exemption evidence and a bank-account copy.
Confirm the three-month recency requirement and which documents actually need issuing.
Review the filing date, itemized receipts and insurer coordination with your worksheet to reduce missed assistance and duplicate counting.
Enter evidence and create your reviewSpecial-copay comparison, Annual copay-cap refunds and Catastrophic medical-expense assistance have different scopes.
Do not automatically add their results; first coordinate payments and refunds for the same costs.