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(영문) 대법원 2016.05.27 2013두901

과다본인부담금확인처분등취소

Text

The judgment below

Among them, "Separate Collection of Expenses for Materials for Medical Treatment" and "collection of expenses for medicines" shall be applied.

Reasons

1. We examine the grounds of appeal on the part of “the separate collection of expenses for materials for medical treatment for separate calculation” and “the collection of expenses for medicines”. A.

In light of the purpose of the national health insurance system and the overall structure of the relevant laws and regulations, health care institutions shall provide health care benefit to subscribers, etc. in accordance with the standards and procedures prescribed by the Acts and subordinate statutes on the criteria for recognition of health care benefit, in principle, unless the so-called non-benefit treatment, which is excluded from the subject of health care benefit under Article 39(3) of the former National Health Insurance Act (amended by Act No. 9932, Jan. 18, 2010; hereinafter the same) is not so-called legal non-benefit treatment, and when the insurer, etc. receives the health care benefit from the insured, etc., the excessive charges to be confirmed and notified by the Defendant under Article 43-2(1) and (2) of the former National Health Insurance Act include not only the “expenses received in excess of the amount of co-payment to be borne by the insured, etc. under the conditions and procedures prescribed by the Presidential Decree among the relevant health care benefit.”

However, even if the medical care institution conducts non-benefit medical care outside the framework of the National Health Insurance, and receives the expenses from the subscribers, etc., there is no procedure such as (i) incorporation of the medical care institution into the subject or non-benefit medical care within the framework of the National Health Insurance Act or reasonably adjusting the relevant medical care benefit costs.