“Income beyond salaries will also be reconciled” ... Will health insurance premiums change for 1.1 million employees?

[Financial News] If the health insurance premium income reconciliation system is expanded to cover the entire population, an estimated 3.94 million households of regional subscribers will have to pay an additional 3.3 trillion won. Meanwhile, 2.32 million households are expected to receive refunds, and the resulting increase in health insurance finances after refunds are deducted from additional collections is projected at about 1.5 trillion won.
According to the National Health Insurance Service’s “Status of Major Business Initiatives,” a report for the National Assembly Health and Welfare Committee’s parliamentary audit, on the 20th health insurance authorities said they plan to introduce a “Nationwide Income Reconciliation System” to improve fairness in premium assessments among subscribers.
The key change is a shift from the current system, in which subscribers apply directly, to one in which administrative agencies check income data and reconcile premiums. An “ex officio reconciliation” system will be applied, reconciling premiums in a single batch once a year based on finalized income data for the previous year provided by the National Tax Service.
Health insurance premiums assessed on workplace subscribers’ salaries are reconciled every April based on their actual pay in the previous year. However, concerns have been raised that, because there is no regular reconciliation process for income beyond salaries earned by regional and workplace subscribers, changes in income are not reflected in premiums in a timely manner.
Under the system, 9.08 million households of regional subscribers will be subject to reconciliation. Another 1.1 million workplace subscribers with income beyond their salaries are also set to be included in the ex officio reconciliation, using income data from the National Tax Service.
An analysis by the National Health Insurance Service of the income of 9.08 million regional-subscriber households found that 3.94 million households had seen their income rise and would have to pay additional premiums. The total amount they would owe was estimated at 3.2911 trillion won.
A total of 2.32 million households are eligible for premium refunds because their income fell, with refunds estimated at 1.8014 trillion won. The service classified 3.9 million households as having no change in income and therefore continuing to pay the same premiums.
The number of households eligible for premium refunds is also expected to increase. In 2025, only 210,000 households of regional subscribers received refunds after applying directly, but with ex officio reconciliation, decreases in income can be reflected without a separate application.
Health insurance finances are expected to see a net increase of about 1.4897 trillion won. This is the amount remaining after deducting the 1.8014 trillion won in refunds from the 3.2911 trillion won to be collected additionally from regional subscribers.
In the reconciliation of workplace subscribers’ premiums conducted this April, additional payments totaled 4.5 trillion won, while refunds amounted to 800 billion won. This increased health insurance finances by 3.7 trillion won.
Authorities plan to use the approximately 1.5 trillion won increase in revenue resulting from the expansion of the income reconciliation system to support regional and essential medical care and strengthen coverage for rare and severe diseases.


[email protected] Han Seung-gon Reporter