4.94 Million Self-Employed Households to Pay Additional 3 Trillion Won in Insurance Premiums

The National Health Insurance Service is pushing to expand the 'income settlement' system, under which self-employed policyholders with increased income pay retroactive premiums each year, to the entire population. Upon introduction, an estimated 3.94 million self-employed households would pay an additional total of 3.2911 trillion won, according to the agency. The details were confirmed through a report the agency submitted to the National Assembly's Health and Welfare Committee audit.

The key change is replacing the current system, which requires policyholders to apply themselves, with one in which administrative agencies verify income data and automatically settle premiums. Under the current system, settlement benefits apply only to workplace-based policyholders, who pay premiums based on the previous year's salary and then pay additional amounts or receive refunds each April based on their confirmed actual income. By contrast, no such settlement process applies to self-employed policyholders' incomes or to workplace policyholders' non-salary income.

Under the new system, annual automatic settlements would be carried out once a year using the previous year's confirmed income data held by the National Tax Service. The targets would be 9.08 million self-employed households and 1.1 million workplace policyholders with non-salary income.

Until now, self-employed policyholders had to apply directly for premium adjustments even when their incomes decreased. As of 2025, only 210,000 households out of 9.08 million had gone through direct applications and received refunds. With automatic settlement in place, 2.32 million households with reduced incomes would receive premium refunds, estimated at 1.8014 trillion won. The net amount added to the health insurance fund, after subtracting refunds from additional collections, is estimated at roughly 1.4897 trillion won.

Health insurance authorities plan to use the roughly 1.5 trillion won secured annually to support regional and essential healthcare systems and to strengthen coverage for rare and severe diseases.