Medical Care Assistance Act


Published: 2011-09-15

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 Article 1 (Purpose)   print
The purpose of this Act is to contribute to the improvement of citizens' health and the enhancement of social welfare by providing indigent citizens with medical care.
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 Article 2 (Definitions)   print
The terms used in this Act shall be defined as follows: <Amended by Act No. 8114, Dec. 28, 2006>
1. The term "beneficiary" means a person entitled to medical care pursuant to this Act;
2. The term "medical care institution" means a medical institution, pharmacy, or a similar institution that provides beneficiaries with medical treatment, preparation of medicine, or medication;
3. The term "obligatory provider" means a person who is responsible for supporting a beneficiary and who is one of a beneficiary's lineal relatives by blood in the first degree or such person's spouse.
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 Article 3 (Beneficiaries)   print
(1) Beneficiaries under this Act shall be as follows: <Amended by Act No. 6875, May 15, 2003; Act No. 7182, Mar. 5, 2004; Act No. 8114, Dec. 28, 2006; Act No. 8609, Aug. 3, 2007; Act No. 8852, Feb. 29, 2008; Act No. 9932, Jan. 18, 2010; Act No. 10784, Jun. 7, 2011; Act No. 11007, Aug. 4, 2011; Act No. 11042, Sep. 15, 2011>
1. Beneficiaries prescribed in the National Basic Living Security Act;
2. Disaster victims prescribed in the Disaster Relief Act;
3. Persons wounded for a righteous cause and their bereaved family members as prescribed in the Honorable Treatment and Support of Persons Wounded or Killed for a Righteous Cause Act;
4. Children under 18 years of age who are adopted into a domestic family under the Act on Special Cases concerning Adoption;
5. Persons recognized by the Minister of Health and Welfare as those who need medical care among persons who are subject to the Act on the Honorable Treatment of Persons of Distinguished Services to Independence, the Act on the Honorable Treatment and Support of Persons, etc. of Distinguished Services to the State, and the Act on Support for Persons Eligible for Veteran's Compensation, and their family members, to whom the Minister of Patriots and Veterans Affairs requests to provide medical care;
6. Persons recognized by the Minister of Health and Welfare as those who need medical care among holders (including honorary holders) of any outstanding intangible cultural heritage designated pursuant to the Cultural Heritage Protection Act and their family members, to whom the Administrator of the Cultural Heritage Administration requests to provide medical care;
7. Persons recognized by the Minister of Health and Welfare as those who need medical care among persons who are subject to the Act on the Protection and Settlement Support of North Korean Refugees and their family members;
8. Persons recognized by the Minister of Health and Welfare as those who need medical care among persons who received compensation pursuant to Article 8 of the Act on Compensation to Persons Associated with to the May 18th Democratization Movement and Similar Matters and their family members;
9. Homeless persons, etc. prescribed in the Act on Support for Welfare and Self-Reliance of the Homeless, etc.;
10. Other persons specified by Presidential Decree as those who are unable to support their own living or who are indigent.
(2) The details of, and standards for, medical care provided to the beneficiaries referred to in paragraph (1) may vary according to the category into which each of them is classified, as prescribed by Presidential Decree.
(3) Matters necessary for the commencement date of medical care to the beneficiaries under paragraph (1) and procedures for selection of such beneficiaries shall be prescribed by Presidential Decree.
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 Article 3-2 (Special Exception to Refugees)   print
A person recognized as refuge pursuant to Article 76-2 of the Immigration Control Act who falls under the scope of the beneficiaries prescribed in Article 5 of the National Basic Living Security Act shall be deemed a beneficiary hereunder.
[This Article Newly Inserted by Act No. 8036, Oct. 4, 2006]
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 Article 4 (Exclusion from Application)   print
No person who receives medical care pursuant to any other Act and subordinate statutes shall be entitled to medical care under this Act.
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 Article 5 (Administrators)   print
(1) Affairs related to the medical care provided under this Act shall be administered by the Special Metropolitan City Mayor, Metropolitan City Mayor, Do Governor, or Governor of a Special Self-Governing Province (hereinafter referred to as "Mayor/Do Governor"), and the head of a Si/Gun/Gu (the head of a Gu means the head of an autonomous Gu; the same shall apply hereinafter) who has jurisdiction over a beneficiary's domicile. <Amended by Act No. 10514, Mar. 30, 2011>
(2) Notwithstanding paragraph (1), if a beneficiary has no fixed domicile, affairs related to the medical care for such beneficiary shall be administered by the head of a Si/Gun/Gu who has jurisdiction over the area in which the beneficiary actually resides.
(3) Each Mayor/Do Governor and the head of a Si/Gun/Gu shall implement programs necessary for maintaining and promoting beneficiaries' health. <Newly Inserted by Act No. 10514, Mar. 30, 2011>
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 Article 5-2 (Case Management)   print
(1) The Minister of Health and Welfare, each Mayor/Do Governor, and the head of a Si/Gun/Gu may conduct case management to strengthen the health care ability of beneficiaries and encourage rational use of medical services, etc.
(2) For case management under paragraph (1), the Special Metropolitan City, each Metropolitan City, Do and Special Self-Governing Province (hereinafter referred to as "City/Do") and each Si/Gun/Gu (referring to an autonomous Gu; the same shall apply hereinafter) shall have a medical care manager.
(3) To provide expert support to the case management program under paragraph (1), the Minister of Health and Welfare may entrust the relevant affairs to a public or private institution, entity, etc.
(4) Matters necessary for administration, including qualifications of and standards for assignment of medical care managers under paragraph (2) and the entrustment of supporting affairs for the case management program under paragraph (3) shall be prescribed by Ordinance of the Ministry of Health and Welfare.
[This Article Newly Inserted by Act No. 10514, Mar. 30, 2011]
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 Article 6 (Medical Care Deliberation Committee)   print
(1) There is hereby established a medical care deliberation committee within the Ministry of Health and Welfare, each City/Do, and Si/Gun/Gu to deliberate on matters concerning the administration of the medical care program under this Act: Provided, That if another committee appropriate for carrying out the functions of a medical care deliberation committee exists in any City/Do or Si/Gun/Gu that shall have a medical care deliberation committee otherwise and if members of such existing committee meet the qualification requirements prescribed in paragraph (4), the existing committee may be authorized to carry out the functions of a medical care deliberation committee, as prescribed by ordinance of the City/Do or Si/Gun/Gu. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010; Act No. 10514, Mar. 30, 2011>
(2) The medical care deliberation committee established within the Ministry of Health and Welfare (hereinafter referred to as the "Central Medical Care Deliberation Committee") shall deliberate on the following: <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
1. Matters concerning basic direction-setting for and establishment of measures for the medical care program;
2. Matters concerning standards for medical care and medical fees;
3. Other matters referred by the Minister of Health and Welfare or the Chairperson of the Committee.
(3) The Central Medical Care Deliberation Committee shall be comprised of no more than ten members, including the Chairperson, and committee members shall be commissioned or appointed by the Minister of Health and Welfare from among the following persons, while the Vice Minister of Health and Welfare shall take the chair of the committee: <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9932, Jan. 18, 2010>
1. Persons who represent public interests (experts in medical security, each of whom shall be an assistant or higher professor in a university or a researcher in a research institute);
2. Persons who represent medical or pharmaceutical circles and persons who represent social welfare circles;
3. Class-III or higher-ranking public officials of appropriate administrative agencies.
(4) Members of the medical care deliberation committee in each City/Do or Si/Gun/Gu established under paragraph (1) shall be commissioned or appointed by the Special Metropolitan City Mayor, the competent Metropolitan City Mayor or Do Governor (hereinafter referred to as "Mayor/Do Governor"), or the head of the competent Si/Gun/Gu from among the following persons, while the competent Mayor/Do Governor or the head of the competent Si/Gun/Gu shall take the chair of the committee: Provided, That if any other committee carries out the functions of the medical care deliberation committee pursuant to the proviso to paragraph (1), the appointment of the Chairperson shall be prescribed by municipal ordinance:
1. Persons who have knowledge and experience relating to medical security;
2. Persons who represent public interests;
3. Public officials of appropriate administrative agencies.
(5) If necessary for deliberation, medical care deliberation committees referred to in paragraph (1) may request an administrator to order public officials under his/her jurisdiction to appear or to submit data. In such cases, the administrator shall comply with such request, unless he/she has justifiable grounds to the contrary.
(6) Matters necessary for the functions of each medical care deliberation committee established within the Ministry of Health and Welfare, each City/Do, and each Si/Gun/Gu and the composition and operation of each medical care deliberation committee shall be prescribed by Presidential Decree. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 7 (Details, etc. of Medical Care)   print
(1) Details of medical care for beneficiaries' illness, injuries, childbirth, and other treatments under this Act shall be as follows:
1. Diagnoses and examinations;
2. Dispensing of medicine and materials for medical treatment;
3. Treatment, surgeries, and other remedies;
4. Inoculation and rehabilitation;
5. Hospitalization;
6. Nursing;
7. Transfer to other hospitals and other measures for accomplishing purposes of medical treatment.
(2) Standards for medical care, including the method of, procedures for, scope of, and the maximum limit on, medical care referred to in paragraph (1), shall be prescribed by Ordinance of the Ministry of Health and Welfare, and standards for, and the method of calculating medical fees shall be determined by the Minister of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) In prescribing standards for medical care pursuant to paragraph (2), the Minister of Health and Welfare may exclude diseases that do not hinder business activities or daily living and other matters specified by Ordinance of the Ministry of Health and Welfare from matters eligible for medical care. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 8 (Medical Care Card)   print
(1) The head of a Si/Gun/Gu shall issue a medical care card to each beneficiary: Provided, That he/she may issue a medical care certificate instead of a medical care card if extenuating circumstances exist.
(2) The period of validity of each medical care card shall be from January 1 until December 31 each year: Provided, That if the period of medical care is otherwise prescribed by any other Act or subordinate statute, the period so prescribed shall be the period of validity of the relevant medical care card.
(3) Where a person to whom a medical care card was issued pursuant to paragraph (1) is re-selected as a beneficiary in the following year, he/she may continue using the medical care card issued upon obtaining confirmation for re-sue by the head of the competent Si/Gun/Gu.
(4) Matters necessary for the form and use of a medical care card and a medical care certificate referred to in paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 9 (Medical Care Institutions)   print
(1) Medical care shall be provided by the following medical care institutions. In such cases, if the Minister of Health and Welfare finds that any of the following institutions is not competent as a medical care institution for public interests or national policies, he/she may exclude such institution from medical care institutions, as prescribed by Presidential Decree: <Amended by Act No. 8114, Dec. 28, 2006; Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010; Act No. 10788, Jun. 7, 2011>
1. A medical institution established pursuant to the Medical Service Act;
2. A community health center, community medical center or branch of any community health center established pursuant to the Regional Public Health Act;
3. A public dispensary established pursuant to the Act on the Special Measures for Public Health and Medical Services in Agricultural and Fishing Villages, etc.;
4. A pharmacy registered pursuant to the Pharmaceutical Affairs Act or the Korea Orphan Drug Center established pursuant to Article 91 of the aforesaid Act.
(2) Medical care institutions shall be classified into any of the following categories, and the scope of medical treatment each medical care institution shall provide shall be prescribed by Ordinance of the Ministry of Health and Welfare: <Amended by Act No. 8114, Dec. 28, 2006; Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010; Act No. 10788, Jun. 7, 2011>
1. Primary medical care institutions:
(a) A medical institution that has reported on establishment with the head of the competent Si/Gun/Gu pursuant to the Medical Service Act;
(b) A community health center, community medical center, or branch of any community health center established pursuant to the Regional Public Health Act;
(c) A public dispensary established pursuant to the Act on the Special Measures for Public Health and Medical Services in Agricultural and Fishing Villages, etc.;
(d) A pharmacy registered pursuant to the Pharmaceutical Affairs Act or the Korea Orphan Drug Center established pursuant to Article 91 of the aforesaid Act;
2. Secondary medical care institutions: Medical institutions established with permission of the competent Mayor/Do Governor pursuant to the Medical Service Act;
3. Tertiary medical care institutions: Medical institutions designated by the Minister of Health and Welfare among secondary medical care institutions.
(3) No medical care institution under any subparagraph of paragraph (1) shall refuse to provide medical care under this Act without justifiable grounds.
(4) When a medical care institution referred to in any subparagraph of paragraph (1) is opened or established or any revision is made to a report on, permission for, or registration of a medical care institution opened or established, each Mayor/Do Governor and the head of each Si/Gun/Gu shall notify the following specialized institutions of the details thereof, as prescribed by Ordinance of the Ministry of Health and Welfare: <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
1. A specialized institution to which the examination and adjustment of costs incurred in providing medical care (hereinafter referred to as "care costs") is entrusted pursuant to Article 33 (2) (hereinafter referred to as "care costs examination institution");
2. A specialized institution to which the disbursement of care costs is entrusted pursuant to Article 33 (2) (hereinafter referred to as "care costs disbursement institution").
(5) Matters necessary for standards and procedures for designation of tertiary medical care institutions under paragraph (2) 3 shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 10 (Apportionment of Care Costs)   print
Care costs shall be borne, fully or partially, by the Medical Care Fund established under Article 25, as prescribed by Presidential Decree, but if the Medical Care Fund bears some of such costs, the remainder thereof shall be borne by each beneficiary. <Amended by Act No. 8114, Dec. 28, 2006>
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 Article 11 (Claims for and Payment of Care Costs)   print
(1) Each medical care institution may claim the head of the competent Si/Gun/Gu to pay the care costs that shall be borne by the Medical Care Fund pursuant to Article 10. In such cases, a request for examination filed under paragraph (2) shall be deemed a claim for care costs to the head of a Si/Gun/Gu. <Amended by Act No. 8114, Dec. 28, 2006>
(2) A medical care institution that intends to claim care costs under paragraph (1) shall file a request for examination of care costs to a care costs examination institution, and upon receiving a request for examination, the care costs examination institution shall examine it without delay and notify the head of the competent Si/Gun/Gu and the medical care institution of the details thereof.
(3) The head of a Si/Gun/Gu, in receipt of notification on details of examination pursuant to paragraph (2), shall pay care costs without delay to the relevant medical care institution in accordance with the details. In such cases, if a beneficiary has overpaid beneficiary charges (referring to the care costs that shall be borne by a beneficiary pursuant to Article 10; the same shall apply hereinafter), an amount calculated by deducting the amount overpaid from the amount payable to the relevant medical care institution shall be returned to the beneficiary: Provided, That the foregoing shall not apply if the amount to be refunded is less than 1,000 won. <Amended by Act No. 8114, Dec. 28, 2006>
(4) In disbursing care costs, if a care costs examination institution evaluates the appropriateness of medical care pursuant to paragraph (2) and notifies the head of a Si/Gun/Gu the results of such evaluation, the head of the Si/Gun/Gu shall adjust care costs by either increasing or reducing care costs according to the results of the evaluation for payment. In such cases, standards for increase and reduction of care costs according to results of evaluation for payment shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(5) Matters necessary for the methods of, and procedures for, claims, examinations, and disbursement of care costs under paragraphs (1) through (4) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 6758, Dec. 5, 2002; Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(6) and (7) Deleted. <by Act No. 6758, Dec. 5, 2002>
(8) If the Korea Worker's Compensation and Welfare Service established under Article 10 of the Industrial Accident Compensation Insurance Act has paid medical treatment benefits prescribed in Article 40 of the aforesaid Act to a person entitled to medical care under this Act, but subsequently revokes the decision on payment and claims the head of a Si/Gun/Gu to pay costs incurred in providing such medical treatment benefits, the head of the Si/Gun/Gu may pay an amount equivalent to the medical care, if the medical treatment benefits are found equivalent to the medical care that may be provided pursuant to this Act. <Newly Inserted by Act No. 8694, Dec. 14, 2007>
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 Article 11-2 (Preservation of Documents)   print
(1) Each medical care institution shall preserve documents relevant to each claim for care costs filed under Article 11 for five years from the day on which the corresponding medical care terminates, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9932, Jan. 18, 2010>
(2) Notwithstanding paragraph (1), pharmacies and other medical care institutions specified by Ordinance of the Ministry of Health and Welfare shall preserve each prescription for three years from the day on which a claim for care costs is filed. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9932, Jan. 18, 2010>
[This Article Newly Inserted by Act No. 7736, Dec. 23, 2005]
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 Article 11-3 (Verification, etc. of Eligibility for Care)   print
(1) A beneficiary may request a care costs examination institution to verify whether any cost borne by the beneficiary in addition to beneficiary charges constitutes the costs incurred in providing treatments beyond the scope of medical care under Article 7 (3) (hereinafter referred to as "non-care costs").
(2) A care costs examination institution in receipt of a request for verification pursuant to paragraph (1) shall notify the person requesting verification of the results of verification, and shall, if the cost regarding which a request for verification was made is verified to constitute a care cost, notify the care costs disbursement institution and the relevant medical care institution of the results, respectively.
(3) A medical care institution shall, upon receiving a notice under paragraph (2), return the over-collected amount to the relevant beneficiary without delay.
(4) If a medical care institution fails to make a refund under paragraph (3), the relevant care costs disbursement institution may deduct the over-collected amount from care costs payable to the medical care institution and return it to the relevant beneficiary.
[This Article Newly Inserted by Act No. 8114, Dec. 28, 2006]
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 Article 11-4 (Prohibited Acts in Relation to Cost Claims by Medical Care Institutions)   print
No medical care institution shall claim a beneficiary to pay beneficiary charges before providing medical treatment or other medical care, or demand a beneficiary to pay any expense, regardless of the title, in addition to the costs that shall be borne by the beneficiary pursuant to this Act and non-care costs.
[This Article Newly Inserted by Act No. 8114, Dec. 28, 2006]
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 Article 12 (Recuperation Expenses)   print
(1) Where a beneficiary receives medical care in relation to a disease, an injury, or childbirth in an institution specified by Ordinance of the Ministry of Health and Welfare as an institution that carries out the same functions as a medical care institution does (including a medical care institution under the suspension of business pursuant to Article 28 (1)), due to an emergency or any other inevitable cause or event specified by Ordinance of the Ministry of Health and Welfare, or where a beneficiary delivers a baby in any place other than a medical care institution, the head of the competent Si/Gun/Gu shall reimburse the beneficiary for an amount equivalent to such medical care, as a recuperation expense, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) An institution that has provided medical care pursuant to paragraph (1) shall issue a recuperation expense statement in the form prescribed by the Minister of Health and Welfare or a receipt with descriptions of recuperation provided to a person to whom it has provided recuperation, and the person who has received such recuperation shall submit the statement or receipt to the head of the competent Si/Gun/Gu. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) Matters necessary for the method of paying recuperation expenses pursuant to paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 13 (Special Exception to Persons with Disabilities)   print
(1) The head of a Si/Gun/Gu may provide beneficiaries with disabilities, who are registered pursuant to the Act on Welfare of Persons with Disabilities, with medical care for orthoses. <Amended by Act No. 8114, Dec. 28, 2006>
(2) Matters necessary for the method of, procedures for, and the scope and maximum limit of medical care in relation to orthoses under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 14 (Health Examinations)   print
(1) The head of a Si/Gun/Gu may conduct health examinations on beneficiaries under this Act to early detect diseases and provide medical care therefor.
(2) Beneficiaries subject to health examinations under paragraph (1), the frequency of, and procedures for such health examinations, and other necessary matters shall be prescribed by the Minister of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 15 (Limitations on Benefits)   print
(1) No head of a Si/Gun/Gu shall provide a beneficiary with medical care under this Act, if the beneficiary falls under any of the following subparagraphs: Provided, That the foregoing shall not apply if the Minister of Health and Welfare deems it necessary to provide medical care: <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
1. If a beneficiary needs medical care prescribed in Article 7 because of a criminal act caused by him/her intentionally or by gross negligence or because of an accident caused by his/her intentionally;
2. Deleted; <by Act No. 8114, Dec. 28, 2006>
3. If a beneficiary fails to comply with any provision of this Act or an instruction given by a medical care institution in relation to medical treatment without justifiable grounds.
(2) If a beneficiary falls under any subparagraph of paragraph (1), a medical care institution shall notify the head of a Si/Gun/Gu who has jurisdiction over the beneficiary's domicile thereof, as prescribed by Presidential Decree.
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 Article 16 (Change of Benefits)   print
(1) If the status of a beneficiary's income or property or a beneficiary's ability to work is changed, the head of a Si/Gun/Gu may change the details of benefits either ex officio or at the request of the beneficiary or his/her relative or other interested person.
(2) When the head of a Si/Gun/Gu changes the details of benefits pursuant to paragraph (1), he/she shall notify the beneficiary thereof in writing, clearly stating the grounds therefor.
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 Article 17 (Discontinuance, etc. of Benefits)   print
(1) The head of a Si/Gun/Gu shall discontinue medical care for a beneficiary if the beneficiary falls under any of the following subparagraphs:
1. If medical care for a beneficiary is no longer required;
2. If a beneficiary refuses medical care.
(2) In cases falling under paragraph (1) 2, medical care for all members of the household to which a beneficiary who refuses medical care belongs shall be discontinued, and no medical care shall be re-provided to any household for which medical care is discontinued during the relevant year.
(3) When the head of a Si/Gun/Gu discontinue medical care pursuant to paragraph (1), he/she shall notify the relevant beneficiary thereof in writing, clearly stating the grounds therefor.
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 Article 18 (Protection of Entitlement to Medical Care)   print
No entitlement to medical care shall be transferred nor be subject to seizure.
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 Article 19 (Right to Reimbursement)   print
(1) When the head of a Si/Gun/Gu provides a beneficiary medical care due to a third party's act, he/she acquire a right to claim damages against the third party within the maximum costs of the medical care.
(2) In cases falling under paragraph (1), if a person to whom medical care provided has already received damages from a third party, the head of a Si/Gun/Gu shall not provide the beneficiary with medical care within the maximum damages he/she has received.
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 Article 20 (Payment of Care Costs by Subrogation)   print
(1) Where some care costs shall be borne by the Medical Care Fund pursuant to Article 10, the remainder of such care costs (limited to an amount determined by the Minister of Health and Welfare) may be paid by subrogation from the Medical Care Fund pursuant to Article 25 at the request of the beneficiary or his/her obligatory provider. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) Matters necessary for the method of applying for payment by subrogation and the method of such payment under paragraph (1) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 21 (Reimbursement of Payment by Subrogation)   print
(1) A person for whom payment by subrogation is made pursuant to Article 20 (including his/her obligatory provider; hereinafter referred to as "person obligated to reimburse payment by subrogation") shall reimburse the payment by subrogation to the head of a Si/Gun/Gu who has jurisdiction over his/her domicile, as prescribed by Ordinance of the Ministry of Health and Welfare. In such cases, reimbursement of payment by subrogation shall bear no interest. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) If a person obligated to reimburse payment by subrogation under paragraph (1) moves his/her domicile to another Si/Gun/Gu, he/she shall reimburse the payment by subrogation to the head of a Si/Gun/Gu who has jurisdiction over his/her new domicile.
(3) The head of a Si/Gun/Gu who receives reimbursement of payment by subrogation pursuant to paragraph (1) or (2) shall transfer the payment to the Medical Care Fund under Article 25.
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 Article 22 (Demands, etc. for Payment)   print
(1) If a person obligated to reimburse payment by subrogation fails to reimburse it by the deadline, the head of the competent Si/Gun/Gu shall, without delay, issue a demand notice fixing a period up to six months from the expiration of the deadline for payment.
(2) If a person obligated to reimburse payment by subrogation fails to do so even after receiving a demand notice pursuant to paragraph (1), the head of a Si/Gun/Gu may collect it in the same manner as delinquent local taxes are collected.
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 Article 23 (Recovery of Unjust Enrichment)   print
(1) The head of a Si/Gun/Gu shall recover benefits or an amount equivalent to care costs, fully or partially, from a person who has received medical care, or a medical care institution that received care costs, by fraud or other wrongful means (including a provider prescribed in Article 11 (5)) as unjust enrichment.
(2) In cases falling under paragraph (1), if medical care has been provided by a medical care institution in collusion with a person who intended to receive medical care, the head of a Si/Gun/Gu may require the medical care institution to return the unjust enrichment under paragraph (1) jointly with the person who has received medical care.
(3) In cases falling under paragraph (1), if a medical care institution has received care costs from a beneficiary by fraud or other wrongful means, the head of a Si/Gun/Gu shall collect such costs from the relevant medical care institution and pay them to the beneficiary without delay: Provided, That the foregoing shall not apply if the amount payable is less than 1,000 won.
(4) If a medical care institution or other person fails to return unjust enrichment, the head of a Si/Gun/Gu may demand the return of such unjust enrichment within a prescribed period.
(5) When the head of a Si/Gun/Gu makes a demand of return pursuant to paragraph (4), he/she shall issue a demand notice to return within a prescribed period of not less than 10 days but not more than 15 days.
(6) If a person in receipt of demand notice under paragraph (4) fails to return unjust enrichment within the prescribed period, the head of a Si/Gun/Gu may collect it in the same manner as delinquent local taxes are collected.
(7) Article 21 (2) and (3) shall apply mutatis mutandis to the recovery, etc. of unjust enrichment.
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 Article 24 (Disposition of Deficits)   print
Where any of the following events occurs, the head of a Si/Gun/Gu may dispose of a payment by subrogation or unjust enrichment as deficit, subject to deliberation by the competent Si/Gun/Gu Medical Care Deliberation Committee:
1. Where the disposition of delinquency is closed but the amount allocated for the amount in arrears is less than the amount in arrears;
2. Where extinctive prescription for the relevant right is completed;
3. Where it is determined unlikely to recover it in any case specified by Presidential Decree.
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 Article 25 (Establishment and Raising of Medical Care Fund)   print
(1) A Medical Care Fund (hereinafter referred to as the "Fund") shall be established within each City/Do to appropriate it for finances for care costs under this Act.
(2) The Fund shall be raised from the following finances:
1. Subsidies from the National Treasury;
2. Contributions from a local government;
3. Payments by subrogation reimbursed pursuant to Article 21;
4. Unjust enrichment recovered pursuant to Article 23;
5. Penalty surcharges collected pursuant to Article 29;
6. Surplus following the settlement of accounts of the Fund and other revenue.
(3) The State and each local government shall secure sufficient budget necessary for the operation of the Fund.
(4) The ratio of subsidies from the National Treasury under paragraph (2) 1 shall be prescribed by the Act on the Budgeting and Management of Subsidies and its subordinate statutes.
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 Article 26 (Management and Operation of Fund)   print
(1) A special account shall be created, separately from general accounts, to manage the Fund.
(2) The Fund shall be used only for care costs, expenses incurred in paying care costs by subrogation, expenses incurred in entrusting business affairs pursuant to Article 33 (2), and other expenses specified by Ordinance of the Ministry of Health and Welfare as expenses directly incurred in providing medical care. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) Each Mayor/Do Governor may manage a surplus, if any, in the Fund in any of the following manners:
1. Depositing it in a financial institution or post office;
2. Purchasing State or public bonds.
(4) Except as otherwise prescribed by this Act, matters necessary for the management and operation of the Fund shall be prescribed by ordinance of each local government, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
law view
 Article 27 (Deposit of Care Costs)   print
(1) If the payment affairs of care costs are entrusted pursuant to Article 33 (2), the competent Mayor/Do Governor shall deposit estimated care costs from the Fund in the care cost payment institution, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) If each Mayor/Do Governor fails to secure a budget for contributions from the local government pursuant to Article 25 (2) 2, he/she shall immediately deposit subsidies from the National Treasury in the care cost payment institution, notwithstanding Article 36 of the Local Finance Act. <Amended by Act No. 8114, Dec. 28, 2006>
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 Article 28 (Business Suspension of Medical Care Institutions)   print
(1) If a medical care institution falls under any of the following subparagraphs, the Minister of Health and Welfare may order the medical care institution business to suspend its business for a period of not more than one year: <Amended by Act No. 8114, Dec. 28, 2006; Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
1. If a medical care institution charges a beneficiary, an obligatory provider, or the head of a Si/Gun/Gu with care costs by fraud or other wrongful means;
2. If a medical care institution demands a beneficiary to pay beneficiary charges in advance, or demands a deposit for hospitalization or other expenses on whatever title, in violation of Article 11-4;
3. If a medical care institution violates an order issued under Article 32 (3), files a false report, or refuses, interferes with, or evades an inquiry or inspection by a public official under his/her jurisdiction.
(2) If a tertiary medical care institution falls under any subparagraph of paragraph (1), the Minister of Health and Welfare may revoke the designation. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) The Minister of Health and Welfare shall not re-designate a medical institution, the designation of which as a tertiary medical care institution has been revoked pursuant to paragraph (2) as a tertiary medical care institution within one year from the date of revocation of such designation. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(4) No person subject to the disposition of business suspension under paragraph (1) shall provide medical care during the period of business suspension.
(5) When the Minister of Health and Welfare makes a disposition under paragraph (1) or (2), he/she shall notify the relevant care costs examination institution and the relevant care cost payment institution of such fact, as prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8114, Dec. 28, 2006; Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(6) Standards for administrative dispositions under paragraphs (1) and (2) shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 29 (Penalty Surcharges, etc.)   print
(1) If the Minister of Health and Welfare shall otherwise make a disposition of business suspension against a medical care institution that falls under Article 28 (1) 1 but he/she finds that the business suspension is likely to cause severe inconvenience to beneficiaries or extenuating circumstances exist, he/she may impose and collect, as a penalty surcharge, an amount not exceeding five times the care costs that it charged by fraud or other wrongful means in lieu of the disposition of business suspension. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) The amount of a penalty surcharge depending upon the type and degree of each violation subject to imposition of the penalty surcharge under paragraph (1) and other necessary matters shall be prescribed by Ordinance of the Ministry of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) If a person obligated to pay a penalty surcharge under paragraph (1) fails to pay it by the deadline for payment, the Minister of Health and Welfare may collect it in the same manner as delinquent national taxes are collected: Provided, That if the authority is delegated to a Mayor/Do Governor, each Mayor/Do Governor may collect it in the same manner as delinquent local taxes are collected. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 30 (Filing Objections, etc.)   print
(1) A person who is dissatisfied with a disposition by the head of a Si/Gun/Gu in relation to a beneficiary's eligibility, medical care, or care costs may file an objection with the head of the competent Si/Gun/Gu.
(2) A medical care institution that is dissatisfied with examinations or adjustments by a care costs examination institution in relation to care costs may file an objection with the care costs examination institution.
(3) An objection referred to in paragraph (1) or (2) shall be filed in writing within 90 days from the day on which the relevant disposition is made: Provided, That the foregoing shall not apply where it is successfully substantiated that a person was unable to file an objection within the period due to a justifiable ground.
(4) Matters necessary for a decision on an objection and the notification of such decision shall be prescribed by Presidential Decree.
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 Article 31 (Extinctive Prescription)   print
(1) Any of the following entitlements shall lapse by prescription if not exercised for three years:
1. An entitlement to medical care;
2. An entitlement to care costs;
3. An entitlement to have a payment by subrogation reimbursed.
(2) The prescription referred to in paragraph (1) shall be interrupted if any of the following events occurs:
1. If a claim for care costs is filed;
2. If a notice or demand of the return of a payment by subrogation is issued.
(3) Extinctive prescription and interruption of prescription shall be governed by provisions of the Civil Act, except otherwise provided by this Act. <Amended by Act No. 8114, Dec. 28, 2006>
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 Article 32 (Reporting and Inspections)   print
(1) The Minister of Health and Welfare may, if deemed necessary, guide or supervise any City/Do or Si/Gun/Gu or require any City/Do or Si/Gun/Gu to file a necessary report regarding matters related to the management and operation of the Fund or medical care. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) The Minister of Health and Welfare may order any medical care institution (including an institution that provides medical care pursuant to Article 12) to submit a report or relevant documents regarding medical care, such as medical treatment or dispensing of medicine or may assign public officials to make inquiries or inspect relevant documents. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) The Minister of Health and Welfare or the head of a Si/Gun/Gu may require a beneficiary of medical care to report on details of the medical care or assign a public official under his/her jurisdiction to make inquiries. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(4) A care costs examination institution may request data necessary for the examination or adjustment of care costs from medical care institutions, and medical care institutions in receipt of a request to provide data shall comply with such request, unless it has exceptional grounds to the contrary.
(5) In cases falling under paragraph (2) or (3), public officials shall carry with them a certificate indicating their authorities and produce it to any relevant person.
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 Article 33 (Delegation and Entrustment of Authority)   print
(1) Part of the authority of the Minister of Health and Welfare under this Act may be delegated to each Mayor/Do Governor, as prescribed by Presidential Decree. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(2) Some of business affairs related to medical care, such as the management of beneficiaries and the examination, adjustment, and payment of care costs, among business affairs under the jurisdiction of the head of each Si/Gun/Gu under this Act may be entrusted to an appropriate specialized institution, as prescribed by Presidential Decree. In such cases, expenses incurred in entrustment shall be borne by the Fund, as prescribed by the Minister of Health and Welfare. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
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 Article 34 (Write-off of Fractions)   print
In calculating costs related to medical care, fractions prescribed in Article 47 of the Management of the National Funds Act shall be disregarded. <Amended by Act No. 7347, Jan. 27, 2005; Act No. 8114, Dec. 28, 2006>
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 Article 35 (Penal Provisions)   print
(1) A person who falls under any of the following subparagraphs shall be punished by imprisonment with prison labor for not more than one year or by a fine not exceeding ten million won:
1. A person who violates Article 9 (3);
2. A person who receives medical care, or who aids and abets a third party to receive medical care, by fraud or other wrongful means.
(2) A person who fails to submit a document or report without justifiable grounds, a person who files a false report, or a person who refuses, interferes with, or evades an inspection, in violation of Article 32 (2) shall be punished by a fine not exceeding ten million won.
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 Article 36 (Joint Penal Provisions)   print
If the representative of a corporation or an agent, employee, or other servant of the corporation or an individual commits an offence under Article 35 in connection with the business of the corporation or the individual, not only shall such offender be punished, but also the corporation or the individual shall be punished by a fine under the relevant provisions.
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 Article 37 (Fines for Negligence)   print
(1) A person who breaches the duty to preserve documents under Article 11-2 shall be punished by a fine for negligence not exceeding one million won.
(2) Fines for negligence under paragraph (1) shall be imposed and collected by the Minister of Health and Welfare, as prescribed by Presidential Decree. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(3) Any person who is dissatisfied with the disposition of a fine for negligence under paragraph (2) may file an objection to the Minister of Health and Welfare within 30 days from the day on which he/she is notified of the disposition. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(4) The Minister of Health and Welfare shall, upon receiving an objection filed under paragraph (3) from a person subject to the disposition of a fine for negligence under paragraph (2), notify the competent court of the objection without delay, and the court shall, upon receiving such notice, submit the case to a trial for fine for negligence pursuant to the Non-Contentious Case Litigation Procedure Act. <Amended by Act No. 8852, Feb. 29, 2008; Act No. 9332, Jan. 18, 2010>
(5) If neither an objection is filed nor fine for negligence paid within the period prescribed in paragraph (3), such fine for negligence shall be collected in the same manner as delinquent national taxes are collected.
[This Article Newly Inserted by Act No. 7736, Dec. 23, 2005]
ADDENDA
Article 1 (Enforcement Date)
This Act shall enter into force on October 1, 2001.
Article 2 (Transitional Measure concerning Beneficiaries of Medical Care)
Beneficiaries of medical care under the former provisions as at the time this Act enters into force shall be deemed beneficiaries under amended provisions of Article 3.
Article 3 (Transitional Measure concerning Medical Care Deliberation Committee)
A medical care deliberation committee established under the former provisions at the time this Act enters into force shall be a medical care deliberation committee established under amended provisions of Article 6.
Article 4 (Transitional Measure concerning Medical Security Card)
Medical security cards issued under the former provisions as at the time this Act enters into force shall be deemed medical care cards issued under amended provisions of Article 8.
Article 5 (Transitional Measure concerning Medical Institutions for Medical)
Medical care institutions under the former provisions at the time this Act enters into force shall be deemed medical care institutions under amended provisions of Article 9.
Article 6 (Transitional Measure concerning Care Costs)
Care costs under the former provisions at the time this Act enters into force shall be deemed care costs under amended provisions of Article 10.
Article 7 (Transitional Measure concerning Medical Care Fund)
The Medical Care Fund under the former provisions at the time this Act enters into force shall be deemed the Medical Care Fund under amended provisions of Article 25.
Article 8 (Transitional Measure concerning Medical Care Institutions whose Designation was Cancelled)
A medical institution whose designation as a medical care institution was cancelled pursuant to the former provisions at the time the amended Medical Care Act (Act No. 5853) entered into force shall, if the period during which re-designation shall be restricted has not ended yet, be deemed to remain subject to the business suspension for medical care during the remaining period pursuant to Article 24 of the aforesaid Act.
Article 9 (Transitional Measure concerning Cancellation of Designation)
Any disposition made against a person regarding whom proceedings were pending in order to cancel designation, suspend a license, impose a fine for negligence, or make a disposition regarding unjust enrichment at the time the amended Medical Care Act (Act No. 5853) entered into force shall be governed by the former provisions in force before the aforesaid Act entered into force.
Article 10 (Transitional Measure concerning Fine for Negligence)
The collection of fines for negligence and unjust enrichment claims imposed pursuant to the former provisions at the time this Act enters into force shall be governed by the former provisions.
Article 11 (Transitional Measure concerning Penal Provisions)
For the purposes of applying penal provisions, acts committed before this Act enters into force shall be governed by the former provisions.
Article 12 Omitted.
Article 13 (Relationships with Other Acts and Subordinate Statutes)
A citation of the former Medical Care Act or any provision thereof by any other Act or subordinate statute in force at the time this Act enters into force shall be deemed a citation of this Act or the corresponding provision hereof in lieu of the former provision, if a corresponding provision exists herein.
ADDENDUM<Act No. 6758, Dec. 5, 2002>
This Act shall enter into force on the date of its promulgation.
ADDENDUM<Act No. 6875, May 15, 2003>
This Act shall enter into force on the date of its promulgation.
ADDENDA<Act No. 7182, Mar. 5, 2004>
(1) (Enforcement Date) This Act shall enter into force on January 1, 2005.
(2) (Applicability to Beneficiaries) The amended provisions of Article 3 (1) 4 shall also apply to any child already adopted by a domestic family pursuant to the Act on Special Cases concerning the Promotion and Procedure of Adoption before this Act enters into force.
ADDENDA<Act No. 7347, Jan. 27, 2005>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2005.
Articles 2 through 4 Omitted.
ADDENDUM<Act No. 7736, Dec. 23, 2005>
This Act shall enter into force three months after the date of its promulgation.
ADDENDUM<Act No. 8036, Oct. 4, 2006>
This Act shall enter into force on the date of its promulgation.
ADDENDA<Act No. 8114, Dec. 28, 2006>
(1) (Enforcement Date) This Act shall enter into force three months after the date of its promulgation.
(2) (Applicability to Relaxation of Restriction on Benefits) The amended provisions of Article 15 (1) 2 shall apply from the first medical care provided after this Act enters into force.
ADDENDA<Act No. 8609, Aug. 3, 2007>
Article 1 (Enforcement Date)
This Act shall enter into force six months after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 7 Omitted.
ADDENDA<Act No. 8694, Dec. 14, 2007>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2008. (Proviso Omitted.)
Articles 2 through 26 Omitted.
ADDENDA<Act No. 8852, Feb. 29, 2008>
Article 1 (Enforcement Date)
This Act shall enter into force on the date of its promulgation. (Proviso Omitted.)
Articles 2 through 7 Omitted.
ADDENDA<Act No. 9932, Jan. 18, 2010>
Article 1 (Enforcement Date)
This Act shall enter into force two months after the date of its promulgation. (Proviso Omitted.)
Articles 2 through 5 Omitted.
ADDENDUM<Act No. 10514, Mar. 30, 2011>
This Act shall enter into force three months after the date of its promulgation.
ADDENDA<Act No. 10784, Jun. 7, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation.
Articles 2 and 3 Omitted.
ADDENDA<Act No. 10788, Jun. 7, 2011>
Article 1 (Enforcement Date)
(1) This Act shall enter into force one year after the date of its promulgation.
(2) and (3) Omitted.
Articles 2 through 11 Omitted.
ADDENDA<Act No. 11007, Aug. 4, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force one year after the date of its promulgation.
Articles 2 through 4 Omitted.
ADDENDA<Act No. 11042, Sep. 15, 2011>
Article 1 (Enforcement Date)
This Act shall enter into force on July 1, 2012.
Article 2 Omitted.