Out-of-Pocket Maximum Refund Estimator
Enter your income tier and this year's covered hospital payments to instantly see your estimated refund and how to claim it.
📝 Your Information
Determined by your health insurance premium — check via NHIS or The건강보험 app if unsure
Covered (insured) out-of-pocket payments at hospitals/pharmacies. Exclude non-covered costs.
⚠️ Non-Covered Items (Excluded)
The costs below are NOT eligible for the out-of-pocket maximum refund. Do not include them in the amount above.
💰 Estimated Refund
Estimated Refund
127만 원
≈ 1,270,000원
127만 원 above the ceiling is your estimated refund.
🗓️ How to Claim
- 📨 Around August each year, the National Health Insurance Service mails a notice for amounts exceeding the ceiling. You can claim after receiving it (or within 3 years of treatment).
- 📱 How to claim: The건강보험 app, the NHIS website (nhis.or.kr) online, or in person/mail/fax at an NHIS branch.
- 🛡️ Private insurance overlap: Refunds from the out-of-pocket maximum may be deducted from private indemnity (실손) insurance payouts. If you already received an indemnity payout, check for overlap.
Data Sources
- 📋 Enforcement Decree of the National Health Insurance Act, Art. 19 [Table 3]
- 🏥 National Health Insurance Service — out-of-pocket maximum guide (nhis.or.kr)
- 📅 Reference year: 2026 tier ceilings
※ This is a reference estimate. Actual eligibility and amounts may differ from the NHIS official calculation. Non-covered costs (implants, premium rooms, etc.) are excluded.
2026 Out-of-Pocket Maximum by Income Tier
| Income Tier | General Ceiling | Over 120 days (LTC hospital) |
|---|---|---|
| 1tier | 90만 원 | 143만 원 |
| 2tier | 112만 원 | 181만 원 |
| 3tier | 112만 원 | 181만 원 |
| 4tier | 173만 원 | 245만 원 |
| 5tier ◀ | 173만 원 | 245만 원 |
| 6tier | 326만 원 | 404만 원 |
| 7tier | 326만 원 | 404만 원 |
| 8tier | 446만 원 | 580만 원 |
| 9tier | 536만 원 | 698만 원 |
| 10tier | 843만 원 | 1,096만 원 |
Guide · FAQ · bal.pe.kr 도구 모음
상한제 구조·비급여 제외는 Guide , 자주 묻는 질문은 FAQ , 데이터 출처·운영 정보는 About 참조. 마지막 업데이트 2026-09-06.