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(영문) 대법원 2012.08.30 2011두7618

과다본인부담금확인처분등취소

Text

The judgment below

Of them, the part of the disposition regarding E and the part concerning the selective medical care costs of B and C shall be excluded.

Reasons

The grounds of appeal are examined.

1. As to the misapprehension of legal principles as to the legality of medical care benefit recognition criteria or medical care benefit calculation criteria different from those of medical care benefit costs (the so-called “non-medical care treatment”).

A. At the same time, the legislative purpose of the National Health Insurance Act, the purport of the national health insurance system, the subject of health care benefit, the standards and procedure for the payment of expenses, and the structure of the national health insurance-related statutes that adopt statutoryism, etc., before being amended by Act No. 9932, Jan. 18, 2010.

(a) The same shall apply;

(3) In principle, unless the so-called statutory non-benefit treatment under Article 39(3) and Article 9 [Attachment 2] of the former Rules on the Standards for Medical Care Benefits in National Health Insurance (amended by Ordinance of the Ministry of Health, Welfare and Family Affairs No. 140, Nov. 30, 2009) are provided, a policyholder or his/her dependent (hereinafter “subscriber, etc.”) according to the standards and procedures set forth in the Act on

Medical care benefits shall be provided to the insurer, policyholder, etc., and medical care benefit benefits shall be paid to the insurer, policyholder, etc., in compliance with the standards and procedures prescribed by Acts and

Therefore, it is in violation of the above criteria even in a case where a medical care institution violates such criteria and procedures, or receives medical care benefit costs from a policyholder, etc. in excess of such criteria and procedures, and arbitrarily provides non-benefit medical care treatment without complying with such criteria and procedures, and receives such medical care costs, etc. from a policyholder, etc. by mutual agreement between the subscriber, etc. and the subscriber, etc., and thus, constitutes a violation of Article 52(1) and (4) and Article 85(1)1 and (2) of the former National Health Insurance Act in principle.

However, on the other hand, it is.