Health Insurance Premium Surges from 5 Million to 100 Million Won in July? The Truth Behind SNS 'Premium Bomb' Claims

"My health insurance premium was around 5 million won until last month, but suddenly I was billed over 130 million won in July."

Recently, complaints from self-employed individuals claiming that their "health insurance premiums spiked in July" have been popping up consecutively on social media.

As claims spread that premiums skyrocketed compared to the previous month and exceeded the 100 million-won mark, some users even reacted by asking if it was fake news.

Meanwhile, others pointed to media reports stating that the government recently reported a restructuring plan for the health insurance contribution system that raises both the upper and lower limits of health insurance premiums, interpreting it as a sign that the government is implementing a sweeping hike in premiums.

Health insurance subscribers are largely divided into employee subscribers and local subscribers.

It is easy to assume that general self-employed individuals fall under local subscribers, but business owners who employ even a single worker are classified as employee subscribers.

This is because Article 6 of the National Health Insurance Act defines "workers and employers at all workplaces" as employee subscribers.

The health insurance premium for employee subscribers is fundamentally calculated as the "monthly remuneration-based premium" (an amount determined by multiplying monthly remuneration by the premium rate).

For example, if the monthly salary is 5 million won, the health insurance premium becomes 359,500 won, reflecting this year's rate (7.19%).

At this time, half is paid by the worker and the other half by the employer, so the health insurance premium actually paid by the worker is 179,750 won.

If there is separate income aside from remuneration, a "remuneration-outside-income-based premium" (an amount obtained by multiplying monthly income outside remuneration by the premium rate) must also be paid.

According to Article 69 of the National Health Insurance Act, the remuneration-outside-income-based premium applies the same rate as the monthly remuneration-based premium to calculate additional premiums "when annual income outside remuneration exceeds 20 million won."

To calculate simply, if there is an additional annual income of 50 million won besides a monthly salary, an extra remuneration-outside-income-based premium of 179,750 won per month must be borne.

However, health insurance premiums do not rise indefinitely just because income is high.

This is because upper and lower limits are set according to relevant laws.

Currently, the upper limit for the monthly remuneration-based premium is 9,183,480 won, and the upper limit for the remuneration-outside-income-based premium is 4,591,740 won.

The monthly salary level at which a person begins paying the monthly remuneration-based premium at its maximum limit is 127,725,731 won.

Expressed as an annual salary, this is approximately 1,532,708,000 won.

In the case of self-employed workplace employers (representatives) who correspond to employee subscribers, business income generated from the workplace they operate (total revenue minus necessary expenses) serves as the basis for calculating remuneration.

At this time, if the annual income is about 1.54 billion won, they must pay the maximum limit of the monthly remuneration-based premium.

If rental income is also generated by leasing real estate separately from the main business at the relevant business entity, this is also included in business income.

The commonality among those who complained on social media that their health insurance premiums had surged was that sudden notification of increased amounts was issued last month.

In response, the National Health Insurance Service explained that this was due to the premium calculation method and timing.

This is because, since income is not finalized during the middle of the year, health insurance premiums are preferentially levied based on "remuneration reported last year," and then when "actual remuneration" is finalized the following year, the difference is reflected to calculate the premiums.

If the actual remuneration was higher, the underpaid insurance premium is collected, while if the remuneration decreased, the overpaid portion is refunded.

Accordingly, the National Health Insurance Service receives reports on the total remuneration of employee subscribers from all workplaces every year.

The designated reporting deadlines are the end of May for self-employed workplace employers and the end of June for faithful reporting employers.

Therefore, for self-employed individuals, premiums may suddenly increase or refunds may occur in June or July depending on the reporting date.

For example, if a subscriber received a monthly salary of 1 million won in 2023, 2 million won in 2024, and 5 million won in 2025, premiums are levied based on the 2023 monthly salary of 1 million won from July 2024 to June 2025, and based on the 2024 monthly salary of 2 million won from July 2025 to June 2026.

Thus, if actual income for 2025 is reported as 5 million won, premiums for the 4 million won income difference from January to June 2025—which were paid based on the 2023 monthly salary—and premiums for the 3 million won difference from July to December 2025—to which the 2024 monthly salary was applied—must be additionally paid all at once.

Cho Hyun-chul of a tax accounting office explained, "Every July, many representatives of employee subscribers wonder why their health insurance premiums suddenly change and settlement statements come out," adding, "In particular, representatives who used to be local subscribers and changed to employee subscribers after hiring employees inquire why things suddenly changed in July."

Are the cases on social media claiming that health insurance premiums spiked over 20 times to reach hundreds of millions of won true? Regarding this, the National Health Insurance Service stated, "While an error might have occurred during the service's reporting process, given that data is cross-examined upon receiving it from the National Tax Service, it is highly likely that the relevant individual representative's income increased significantly last year."

Since self-employed workplace representatives are employers and subscribers at the same time, they bear a greater burden because, unlike other workers, they must also pay half of the monthly remuneration-based premium that the company is supposed to cover.

The service explained that if the calculated differences in health insurance premiums for employees that the company must shoulder are also partially reflected here, the total payment amount may look even larger.

This is because if employees' monthly salaries have risen, the premium difference grows accordingly, and the amount that the workplace representative must bear also increases.

A service official explained, "Explanations of levy details for each subscriber as well as the representative themselves are included together on the bill," adding, "Detailed breakdowns can be checked through phone inquiries to the service or via computerized lookup."

Furthermore, policy changes guessed by some on social media as one of the causes of the premium surge are not true.

This is because, although the Ministry of Health and Welfare reported a health insurance contribution system restructuring plan containing content to raise the upper limit of health insurance premiums from the current "30 times the average premium of 2 years ago" to "40 times" at a subcommittee of the Health Insurance Policy Deliberation Committee last month, improving the health insurance premium levy standards is a matter requiring deliberation by the committee and revision of laws and decrees, and the restructuring plan has not been finalized or implemented.

The service advised that if the premium settled due to reasons such as year-end tax settlement is greater than the premium billed for the current month, application for installment payments in up to 12 installments can be made.
※ Please note: This article was translated by AI and may contain errors.