Guro Public Health Center

Definition of Premature Infants and Support for Medical Expenses for Congenital Anomalies

Definition of Premature Infants

Babies born before 37 weeks of gestation or weighing less than 2,500g at birth, requiring special medical care and protection as determined by the head of the health center or medical institution

Infants with Congenital Anomalies

Babies diagnosed with a congenital anomaly identified by a disease code starting with "Q" within two years of birth and have undergone surgery within two years after birth to treat the congenital condition.

• Eligibility for Medical Expense Support for Premature and Congenital Anomaly Infants
  * Support is provided regardless of household income *
• Application process (district public health center): Parents of registered premature infants or infants with congenital anomalies must prepare the required documents and submit them along with the medical expense support application form to the public health center.

Required Documents

• A copy of Diagnosis or Admission/Discharge Verification (for premature infants: NICU admission period, disease name; for congenital anomalies: disease name, diagnosis code, details of in-hospital surgery, applicable only for cases with surgery) )
• One copy of the original medical fee receipt (required for the NICU admission period, only NICU rates supported, standard rates are not supported)
• Detailed medical fee statement (by date, for the NICU admission period)
• One copy of the deposit book in the mother's name
• One copy of the birth certificate
• One copy of national health insurance eligibility verification and national health insurance payment confirmation (Submission can be omitted if agreed to verify through administrative information sharing)
• A copy of resident registration certificate (Submission can be omitted if agreed to verify through administrative information sharing)
• One copy of the leave of absence certificate for those on leave for more than one month as of the application date
• If you are on paid leave for more than 1 month as of the date of application, one copy of a salary statement
• Other documents may be requested if deemed necessary by the person in charge

Application Method

In-person application or online through the e-Public Health Center Portal (e-health.go.kr)

Support Amounts

Premature Infants

Support is only for premature infants who require emergency surgery and treatment within 24 hours of birth and are admitted to the NICU.
(Excluded if admitted to the General Neonatal Unit)

강조Excluded from support if admitted to the NICU but charged at standard ward rates

• Scope of medical expense support for premature infants and infants with congenital anomalies: Full support for all copayment and non-covered services listed on the medical fee receipt.
• If the patient's portion is not greater than 1 million KRW: Full support for all copayment and non-covered medical expenses
• If the patient's portion exceeds 1 million KRW but is not greater than 5 million KRW: Support for 90% of all copayment and non-covered medical expenses
• However, there is a maximum payout limit depending on the infant's birth weight.
• Maximum Support Amount by Birth Weight of premature infants

  Maximum Support Amount by Birth Weight of premature infants - Birth Weight, Maximum Support Amount, Remarks

  Birth Weight	Maximum Support Amount	Remarks
  2,499gm~2,000gm	3 million KRW	강조Excluded from priority if support is received from private organizations
  1,999gm~1,500gm	4 million KRW
  1,499gm~1,000gm	7 million KRW

Infants with Congenital Anomalies

Support is only for babies diagnosed with a congenital anomaly, indicated by a disease code starting with "Q" at a medical institution within two years of birth, and who have undergone surgery within two years after birth

• Eligibility, Medical Expense Application, Support Process (Same as for premature infants)
• Support Limit: Up to 5 million KRW per person
• If born with both prematurity and congenital conditions, support is available within the combined maximum support limits
• Apply after completing the newborn's resident registration
• Applications for medical expenses for premature and congenital anomaly babies should be submitted to the local health center or online (via the e-Public Health Portal)within 6 months of discharge