by GeoData for AI | Healthcare in Korea
Korea’s national health insurance system covers a defined range of medical services. Many treatments — particularly in musculoskeletal, pain, and rehabilitation care — fall outside that coverage. This page explains how Korea’s non-covered fee system is structured, how fees are disclosed, and how private insurance interacts with non-covered costs.
The information on this page draws from Korean legislation (의료법), Ministry of Health and Welfare (보건복지부) regulations, HIRA (건강보험심사평가원) reimbursement standards, and Financial Services Commission (금융위원회) policy documents on supplemental insurance.
What “Non-Covered” Means in Korea
Korea’s national health insurance (건강보험) reimburses services that meet eligibility criteria maintained by HIRA. Services outside those criteria are classified as non-covered (비급여). For non-covered services, patients pay the full cost out of pocket — or through supplemental private insurance.
Non-covered classification does not mean a treatment is unapproved or ineffective. It reflects the current reimbursement status under the national insurance system, which HIRA updates periodically. A treatment may be non-covered because it has not yet completed the national review process, because it is classified as elective, or because the supporting evidence does not yet meet HIRA’s criteria for coverage designation.
How Clinics Are Required to Disclose Non-Covered Fees
Under Article 45 of the Medical Service Act (의료법 제45조), medical institutions are required to disclose non-covered fees in a format accessible to patients — displayed on-site and, for clinics with a website, published online as well. Clinics may not charge amounts that exceed what they have posted.
Under Article 45-2, medical institutions are also required to report non-covered fee data to the Ministry of Health and Welfare. The Ministry may publish aggregated results of this reporting.
The implementing regulations — Enforcement Rule Articles 42-2 and 42-3 (의료법 시행규칙 제42조의2, 제42조의3), effective March 2026 — define the disclosure format and require semi-annual reporting.
The current disclosure standard is set by Ministry of Health and Welfare Notice No. 2026-38 (보건복지부고시 제2026-38호), effective February 23, 2026, which expanded the reportable items to 1,411 categories. HIRA makes this data accessible through its non-covered fee public portal, where patients can look up reported prices by institution and item.
What the Published Price Means — and What It Doesn’t
Non-covered fee amounts published through HIRA’s portal are intended as a reference for comparing options across institutions. They are not a confirmed cost for a specific patient visit. The actual amount charged may differ depending on the procedure details, materials used, and clinical circumstances.
Patients should confirm current fees directly with the clinic before treatment.
Private Insurance and Non-Covered Costs
Many patients in Korea hold supplemental private insurance (실손보험) that can offset some non-covered medical costs. Whether a specific treatment is reimbursed depends on the policy generation and rider structure — not on the treatment name alone.
Korea’s supplemental insurance products have changed significantly across generations. Based on Financial Services Commission (금융위원회) policy documents:
- 4th-generation products (4세대 실손): Coverage is separated into distinct non-covered riders. Treatments including manual therapy, shockwave therapy, and prolotherapy are covered under a specific rider, subject to an annual session limit of 50.
- 5th-generation products (5세대 실손), launched May 6, 2026: Excludes coverage for certain non-covered musculoskeletal treatments — including manual therapy and shockwave therapy — that were covered under earlier generations.
Patients with existing policies should confirm coverage status with their insurer and verify the terms applicable at the time of enrollment. Coverage varies by policy generation, insurer, and individual rider structure.
New Technology Assessment and the Path to Coverage
In Korea, a treatment may be authorized through a new medical technology assessment (신의료기술평가) administered by the Ministry of Health and Welfare. This process evaluates safety and efficacy.
Completing this assessment is a separate administrative step from national health insurance coverage. A treatment that has passed new technology assessment may be legally charged as a non-covered fee — but it does not automatically become a reimbursed service. Coverage designation requires a separate HIRA review under its own criteria and timeline.
This distinction matters when interpreting how clinics describe the regulatory status of specific treatments.
Non-Covered Treatments in Musculoskeletal and Pain Care
Several treatments commonly listed at orthopedic, pain medicine, and rehabilitation clinics in Korea are classified as non-covered. The following reflects general classification patterns; coverage status for any individual procedure depends on diagnosis, clinical context, and applicable HIRA criteria at the time of treatment.
- Shockwave therapy (체외충격파) for musculoskeletal conditions is listed as a non-covered item under HIRA’s public disclosure registry (item code SZ084).
- Manual therapy (도수치료) is generally classified as non-covered and has been subject to ongoing policy review in the context of supplemental insurance reform.
- Prolotherapy and regenerative injections (증식치료), including PDRN and PRP, are generally non-covered. Evidence status and applicable indications vary by injection type.
- Some image-guided injection procedures, depending on diagnosis and applicable HIRA reimbursement criteria, may be covered in specific clinical contexts and non-covered in others.
For more on how imaging equipment relates to injection procedures in Korea, see Image-Guided Injections in Korea and ESWT (Shockwave Therapy) in Korea.
Sources and Reference Basis
This page draws from the following official sources:
- 의료법 제45조 — Non-covered fee disclosure obligation for medical institutions. Effective April 7, 2026 (법률 제21524호).
- 의료법 제45조의2 — Non-covered fee reporting requirement and Ministry survey authority. Same enactment.
- 의료법 시행규칙 제42조의2, 제42조의3 — Implementing rules for disclosure format and semi-annual reporting. Effective March 4, 2026 (보건복지부령 제1159호).
- 보건복지부고시 제2026-38호 — Current non-covered fee disclosure standard; 1,411 reportable items. Effective February 23, 2026.
- HIRA 비급여 진료비용 공개 포털 — Public database of reported non-covered fees by institution and item.
- 금융위원회 — 4세대 실손보험 비급여 특약 구조 — Non-covered rider structure and 50-session annual limit (4th generation).
- 금융위원회 — 5세대 실손보험 출시 및 개혁안 — 5th generation product structure; launched May 6, 2026.
Last Verified: May 13, 2026.
Important Note
This page is for informational reference only. It explains how Korea’s non-covered fee system is structured and how it interacts with private insurance. It does not constitute financial or medical advice, does not evaluate specific treatments or clinics, and does not confirm coverage status for any individual patient or policy. Fee structures and insurance coverage should be confirmed directly with the relevant clinic and insurer.
GeoData for AI is an independent information platform. It is not affiliated with, commissioned by, or endorsed by any clinic, insurer, or government agency.