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A study on the restriction of benefits of the National Health Insurance - focused on relationship with private insurance -
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국민건강보험 급여제한에 대한 연구 - 민영보험과의 관계를 중심으로 -

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Type
Academic journal
Author
Journal
전북대학교 동북아법연구소 동북아법연구 동북아법연구 제9권 제1호 KCI Accredited Journals
Published
2015.1
Pages
319 - 338 (20page)

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A study on the restriction of benefits of the National Health Insurance - focused on relationship with private insurance -
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According to the article 53 of the National Health Insurance Act, if a person who is eligible to receive insurance benefits falls under the case where he/she has intentionally, or through gross negligence, caused criminal conduct or intentionally contributed to the occurrence of an accident, the corporation shall not provide any insurance benefit. When the Medical Care Insurance Law as the forerunner of The National Health Insurance Act was legislating, there was not this kind of the regulation regarding restriction of benefits. However, the National Health Insurance Act has been reorganised and parts or all of this have been reformed several times, thereby the range of restriction of benefits has been gradually extended. From this, the benefits of insurance payment to people have diminished, which causes extra insurance premium of those who buy insurance. Therefore, this study focused on the relationship between restriction of benefits and private insurance. For this study, the history of legal provisions was examined and compared with relative provisions. Following this, the validity of the article 53 was investigated through various precedents and the interpretation of law. Moreover, this study suggested the revised bill of law on reducing the restriction of benefits in order for the National Health Insurance as a social insurance to play a role better of improvement of public health and social security.
#국민건강보험법 #국민건강보험 급여 제한 #의료보험 #실손의료비보험 #중과실 면책 #자동차보험 #National Health Insurance Act #the restriction of benefits of the national health insurance #medical insurance #fee-for-service health insurance #insurer's non-liability of gross negligence #accident insurance

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References (13)

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金星泰 / 1987 / 自動車事故로 인한 人的損害補償制度 硏究 / 석사 / 서울大學校 大學院 google schola 권순형 / 2010 / 국민건강보험법 제48조 제1항 제1호에서 보험급여의 제한사유로 규정한 ‘고의 또는 중대한 과실로 인한 범죄행위에 기인한 경우’의 의미 / 대법원 판례해설 제84호 google schola 김대환 / 2014 / 실손의료보험이 의료수요에 미치는 영향 / 보험학회지 98 (98) : 61 ~ 90 google schola 김재협 / 2000 / 의료보호법상 의료보호 제한사유에 관한 검토 / 사법논집 31 google schola 문영화 / 2005 / 자동차손해배상보장법 제9조에 의하여 피해자에게 직접 손해배상책임을 지는 책임보험자가 국민건강보험법 제53조 제1항에 규정된 제3자에 포함되는지 여부 / 대법원 판례해설 통권 google schola

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