“IF YOU have resided for more than six months in the Republic of Korea, you will be mandatorily subscribed to the National Health Insurance (NHI) of Korea from July 16, 2019.” This is an excerpt from the letter that the National Health Insurance Service (NHIS), affiliated to the Ministry of Health and Welfare (MOHW), sent to all registered foreigners on May 15, 2019. This sudden notice affected all foreign nationals residing in Korea, including international students who have already been required to pay for insurance to their Korean universities. Though the government has been planning to implement this policy since June, 2018*, it was only in this year the administration first informed universities and international students. With no further details regarding what constitutes the expensive fees of the NHI, and the logistics of the execution of the revised policy, the university faculty and international students are left in confusion.
On May 12, 2019, the MOHW officially announced that all foreign nationals and Korean expatriates who have or are planning to reside in Korea for more than six months will be mandatorily subscribed to the NHI starting from July 16, 2019. The NHIS explained that a revision in current policy was necessary to restrict foreigners from abusing the NHI**. Prior to the government’s announcement, foreigners had an option to subscribe to the NHI if they had stayed in Korea for more than three months. Since there were no additional requirements, foreigners could easily subscribe to the state health program and enjoy its extensive benefits. This resulted in incidents of exploitation where foreigners would receive medical services that cost more than the insurance fees, also known as premiums. Since there is a limited budget to cover up the substantial expenses, the NHIS has been suffering from budget deficits. The NHIS has reported that the total amount of deficits has increased by more than 100 billion from 2013 to 2017. It has added that foreigners have received insurance benefits of more than 3.4 times the premiums they had paid in those five years. In an interview with The Korea Herald, a MOHW official said that by having all foreigners subscribed to the NHI, the government plans to compensate for the deficit in the NHIS. By requiring a longer duration of stay in Korea, the administration also aims to eliminate a loophole in the system that allowed foreigners to leave the country permanently without paying for the expensive medical services covered by the NHI.
In relation to the revision in insurance policy, the administration announced that it will limit the coverage of the NHI for those who default on state health insurance fees***. As a method to reinforce the state health program, the Ministry of Justice (MOJ), declared that it will restrict visa extensions to foreigners who have failed to pay insurance payments three times****. The NHIS explained that the state health plan is expected to affect around 400,000 foreign nationals, boosting the number of foreign subscribers to an estimated 1.2 million in total. This increase is expected to compensate for the losses in the NHI caused by those exploiting the loophole in the state health insurance system. Stricter enforcement of visa laws is anticipated as well, as the payment of the NHI premiums becomes a major criterion in visa extensions*****. While the need to enforce stricter insurance laws is understandable, it is questionable whether international students should be required to have the national health plan.
Mandatory subscription to health insurance programs for international students is not completely new, as Yonsei University has required international students to apply for insurance before their admission. In an interview with The Yonsei Annals, Han, a school personnel******, said, “Since 2015, the Ministry of Education (MOE) has required all international students to apply for medical insurance in case of any emergencies that might arise during their stay in Korea.” In the Yonsei University Fall 2019 Admissions Handbook, it is said that all incoming international students are required to be enrolled in any of the three insurances: the NHI, the School Group Insurance, or a private insurance from one’s own country that has global coverage. For students who fail to apply for insurance before the course registration period, Yonsei restricts their access to the Yonsei Web Portal, which is crucial for course registrations. Yet, despite acknowledging the need for an insurance policy for international students, many students and universities alike have criticized the government’s direction of making its state health program compulsory.
Differences in health insurances
The major cause of the controversy regarding mandatory subscription to the NHI rests on the fact that the national plan is significantly more expensive than existing insurance programs offered by universities. Besides the NHI and an insurance program from students’ own countries, Yonsei provides the School Group Insurance program for the international students. Han said that Yonsei uses an insurance program that is designed specifically for international students. The basic coverage includes illnesses, injuries, hospitalization, deaths and a transfer service of the deceased to their family members. The subscription costs around \100,000- \110,000 yearly, which amounts to around \8,500-\9000 per month.
The NHI, on the other hand boasts a more extensive coverage, reflected in its costly premiums. According to the NHIS, the state insurance plan offers more supplementary services like free yearly medical examinations, deductibles to a minimum of 30%, MRI scans for certain areas and free cancer diagnosis. Han said, “Unlike the school insurance, which returns a fixed percentage of the total medical expenses paid their uninsured to the hospital, the NHI immediately provides parts of the fees that the students are charged in medical facilities, thus decreasing the total expenses.” Under the NHI policy, all foreigners should pay insurance premiums that are calculated based on their income and property in Korea upon enrollment into the NHI. If the calculated rate is below the average of that of all subscribers, the average premium is imposed—an estimated 113,050 per month*******. However, because international students mostly do not have any property or income in Korea, the MOHW will charge only half of the average premium—\56,525—to those in degree programs; all other foreign nationals will be charged otherwise. Nevertheless, international students will be charged more than what the school had required through the School Group Insurance.
Despite the wider spectrum of benefits from the NHI, international students are skeptical of the need for another insurance program. Yu Jie Liu (Fresh., Dept. of German Language & Lit.), an international student from China, said, “I heard that we can get the same benefits as Korean citizens, but I don’t think there will be much difference from other insurances. I don’t know why I would have to pay for an exceedingly more expensive insurance.” Likewise, Yonsei worries that the mandatory subscription to NHI might discourage students from applying for the school insurance. Unlike the School Group Insurance, the NHI does not cover cases of death and a transfer service of the deceased to family members in home countries. “Unfortunate deaths of international students have occurred in the past,” said Han, “Thus, we need to be prepared for such tragic incidents. In the worst-case scenario, we might have to require students to apply for the school insurance [on top of the NHI].”
As the NHI premium demands an amount almost six times that of the School Group Insurance, it is expected that the international students will face economic pressure. Current visa laws state that international students enter the country with either the D-2 (degree students) or D-4 (language trainees); these visas allow students to work only under the condition that they have resided in Korea for more than six months. However, under the revised insurance laws, foreigners who are planning to reside in Korea for more than six months are to mandatorily subscribe to the national plan immediately upon their entry in Korea. Liu said, “The insurance fees are just too expensive. Not all international students come from rich families, and this will be too burdensome to many of us. It is just not worth it.”
The administration also failed to provide a clear answer regarding the insurance costs of state scholarship students—international students whose academic and living expenses are all paid by the Korean government. Han said, “There are approximately 200 state scholarship students in Yonsei, so I asked how they will be taken care of; the MOE just said that they didn’t know.”
A revision not well thought through
The MOHW’s decision has been criticized for failing to provide accurate notices prior to the change in policy. Han said, “When I went to a conference hosted by the government, an official from the NHIS suddenly announced that all international students will mandatorily be subscribed to the NHI starting July 16. We were all baffled because we haven’t heard anything about this.” Not only did the government fail to inform universities, it also disregarded international students who were to be directly affected. Following the announcement of the revised NHI policy, the MOHW sent out official mail regarding the mandatory subscription to the NHI to all registered foreigners. Liu said, “I was really shocked when I first heard about this. All of my friends didn’t know anything about it before we received the letters.” Two days after the sudden briefing for college officials, an anonymous university personnel posted a petition on the Blue House website, calling for the abolishment of the compulsory enrollment of the state health program. The petition has since amassed more than 100,000 signatures as of June 8, 2019.
The NHIS has installed more Public Service Centers to help foreigners who are confused about the state health program. However, the actual services of these facilities do not reflect the promises of the NHIS. Liu said, “When I called the NHIS to ask about the insurance, they were very unclear. We did not understand what they were saying.” Han shared a similar account, “So many students came to the office panicking about the NHI. To figure out what was going on, I called the NHIS, but all I got was the answer, ‘I have no idea.’”
According to the MOHW, following the revised laws, foreign nationals who stay outside of Korea for more than one month will have their subscription to the NHI terminated. Once those foreigners come back to Korea, they are to follow the whole process of registering for the NHI again. Since breaks in Korean universities last almost three months, students who have decided to go back home for the break are expected to register again for the national health plan upon return. Han added, “State scholarship students have to report to the school office before they leave Korea, but how can I look through each and every one of their entry and departure records? We have to be the ones to remind them again about their NHI subscription.”
After the postponement
Upon receiving continuous criticism and official complaints from universities, the MOHW decided to postpone the insurance amendments until March, 2021. However, the way the administration announced the postponement was once again, not free from criticism. Han said, “I first found out about the delay while I was on my way to another meeting with university officials.” Han added that the MOHW did not send any additional letters to the students regarding their decision. “Nothing was explained clearly from the beginning to the end,” said Han. “My friends and I just felt helpless,” said Liu, “It feels like there is nothing that we can do. If we want to stay in Korea, I guess we just have to blindly follow that [abrupt change in policy].”
With the subscription to the NHI on hold, Yonsei has decided to continue its original insurance policy. However, the status of the MOHW’s decision is a postponement at best. Since the coverage and benefits of the School Group Insurance are different from those of the state health program, international students are expected to enroll into both plans. Han said, “The worst-case scenario is the government pushing through with the NHI, and in that case, we may have to require students to also have the School Group Insurance.” However, Liu expressed concerns, “It would just be too expensive if we had to join both insurance programs.”
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The NHI was first made with the aim to promote universal health care for all citizens. Though it is noble of the government to attempt to include foreigners in the pool of beneficiaries, the inadequate sharing of information and negligence of the international students’ situations eclipse the administration’s efforts. Along with the revision, the government’s postponement seems to feed the confusion and concerns of university officials and the students. “I understand that there is a deficit in the national health plan, but international students should not be the victims. We should blame those that abused the policy, not incoming students who are coming to Korea with high hopes,” said Han. “It is not our fault. Students like us just came here to study; we have nothing to do with all this,” said Liu, in her final comments.
*The Korea Herald
**The Korea Times
***The Korea Economic Daily
****The Korea Herald
*****People’s Solidarity for Participatory Democracy
******The interviewee requested anonymity.
*******National Health Insurance Service