[2] In a case where a medical care institution conducts arbitrarily non-benefit medical treatment and does not constitute excessive personal charges, the medical care institution bears the burden of proof (=medical care institution)

[3] Where the Act on the Standards for Medical Care Benefits, etc. was amended after medical treatment by a medical care institution, whether the Act on the Standards for Medical Care Benefits, etc. can be applied retroactively to the time of medical treatment (negative in principle).

[2] In light of the medical treatment contract concluded with the insured, etc., medical personnel, etc. are not obligated to perform the best medical treatment under the Medical Service Act, as well as to make efforts to provide the patient with the best medical service. Considering that patients such as the insured have the right to receive effective and appropriate medical treatment without any excessive burden of expenses for diseases, injury, etc., even in cases where the medical care institution arbitrarily conducts non-benefit medical treatment outside the framework of the National Health Insurance, and received expenses from the insured, etc., in the absence of procedures such as (i) inclusion of it in the relevant Acts and subordinate statutes implemented at the time of the medical treatment into the national health insurance framework or reasonably adjusting the relevant medical care benefit cost; and (ii) it is difficult to deem that the medical care institution was avoided in light of the details of the procedure, urgency and urgency as well as the required time and the process of the procedure, etc.

[3] Whether the cost of a medical care institution’s medical care institution’s performing medical care and receiving the cost is excessive shall be determined in accordance with the medical care benefit standard and the medical care benefit cost calculation standard established under the relevant Act and subordinate statutes implemented when the medical care institution provides and receives the cost. Thus, whether the cost of a medical care institution’s receiving the cost of medical care constitutes excessive personal charges under Article 43-2(1) and (2) of the former National Health Insurance Act (amended by Act No. 9386, Jan. 30, 2009) should be determined based on the relevant Acts and subordinate statutes, such as the medical care benefit standard, not the amended medical care benefit standard, but the medical care benefit standard, etc. at the time of the medical care. Thus, barring any special circumstance, the amended Acts and subordinate statutes concerning the medical care benefit standard, etc

1. As to the misapprehension of legal principles as to the subject of the disposition of confirmation and notification

A. (1) According to Articles 41 and 43-2 of the former National Health Insurance Act (amended by Act No. 9386, Jan. 30, 2009; hereinafter the same), a policyholder of a national health insurance or his/her dependent (hereinafter “subscriber, etc.”) may request the Defendant to verify whether the expenses incurred in relation to the medical care benefits, other than the amount of co-payment, to be borne by himself/herself, are excluded from the subject of the medical care benefits under Article 39(3). Upon receipt of such request, the Defendant shall notify the relevant medical care institution of the purport that the expenses requested for confirmation are excessive charges, and the medical care institution so notified shall promptly pay the applicant for confirmation his/her excessive charges.

Based on the purport of the national health insurance system, the system under the National Health Insurance Act, such as the subject of, criteria for, and procedures for, medical care benefits, legal principles on non-benefit eligibility, etc., is examined. In principle, unless the so-called legal non-benefit treatment that is excluded from the subject of medical care benefits under Article 39(3) of the former National Health Insurance Act is not the legal non-benefit treatment, health care institutions shall provide health care benefits to subscribers, etc. in accordance with the standards and procedures prescribed by the Act and subordinate statutes on the criteria for recognition of health care benefits, and even when the insurer, subscribers, etc. are paid the health care benefit, the standard and procedure prescribed by the Act and subordinate statutes on the criteria for calculation should be complied with (see Supreme Court en banc Decision 2010Du27639, 2766, Jun. 18, 2012). The scope of excessive charges to be verified and notified by the Defendant under Article 43-2(1) and (2) of the former National Health Insurance Act includes not only the amount to be borne by the insured, etc.

(2) However, on the other hand, given that a medical person, etc. is not obligated to perform the best medical treatment pursuant to a medical contract concluded with a subscriber, etc., as well as that a medical person, etc. is obligated to endeavor to provide a patient with the best medical service pursuant to the Medical Service Act, and a patient, such as a subscriber, etc. is entitled to receive effective and appropriate medical treatment without any excessive burden of expenses for illness, injury, etc., even in cases where the medical care institution arbitrarily provides non-benefit medical treatment outside the National Health Insurance framework and received such expenses from the subscriber, etc., (i) under the relevant Acts and subordinate statutes implemented at the time of such medical treatment, such as inclusion into the medical care benefit object or non-benefit within the National Health Insurance framework or the relevant medical care benefit cost can be reasonably adjusted, even if there is no procedure such as reasonably adjusting the relevant medical treatment cost, it is difficult to deem that the medical care institution avoided it in light of specific circumstances such as the content and urgency of such procedure and the process, etc. < Amended by Act No. 1820, Jul. 26, 20197>

B. Under the premise that the medical care institution conducts medical care and collects the expenses from the subscribers, etc., the medical care institution must follow the standards and procedures stipulated in the relevant Acts and subordinate statutes, the insurer shall not be charged with the patient’s expenses that the medical care institution cannot be claimed from the insurer because it goes beyond the medical care benefit standards, and the medical care act was medically adequate, the lower court determined that the Plaintiffs’ non-benefit test conducted with the mother in the course of operating the medical care institution does not constitute the medical care benefit object under the Act on the Standards for Recognition of Medical Care Benefits at the time of its enforcement, and does not constitute the medical care benefit object under the Act on the Standards for Recognition of Medical Care Benefits at the time of its enforcement and does not constitute the legal non-benefit medical care act. The lower court determined

C. However, in light of the legal principles as seen earlier, the Plaintiffs’ assertion to the effect that, even if the instant non-payment treatment constitutes a voluntary non-payment treatment, the costs thereof do not constitute an excessive personal charges. Therefore, the lower court should have deliberated and determined whether the costs of the instant non-payment treatment cannot be viewed as an exceptionally excessive personal charges.

Therefore, in so determining, the lower court erred by misapprehending the legal doctrine on the subject of the notification of excessive personal charges under Article 43-2(1) and (2) of the former National Health Insurance Act, thereby failing to exhaust all necessary deliberations, thereby adversely affecting the conclusion of the judgment.

2. As to the misapprehension of legal principles as to the application of new medical technology

The lower court rejected the Plaintiffs’ assertion on the ground that the former Before delivery was already stipulated as medical care benefits subject to the Health Insurance Medical Care Benefit and its relative value (established by Ministry of Health and Welfare No. 2000-67, Dec. 8, 2000) at the time when the Plaintiffs conducted the de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto de facto.

In light of relevant Acts and subordinate statutes and records, such determination by the court below is just, and there is no error in the misapprehension of legal principles as to the interpretation or scope of “new medical technology” under Articles 13(1) and 10(1) of the Regulations on Standards for Medical Care Benefits.

3. As to the misapprehension of legal principles as to the application of amended Acts and subordinate statutes on medical care benefit standards

In light of the principle of the rule of law and the provisions of Article 13 of the Constitution, barring special provisions, such as the provision of transitional provisions that the new law shall apply in favor of the persons subject to the amendment, the former law prior to the amendment shall be applied instead of the new law after the amendment: Provided, That even if the new law is retroactively applied, where there is no direct relation to the interests of the general public, and where there are special circumstances, such as promoting the interests of the general public and removing disadvantages or pains, the retroactive application of the law shall be exceptionally allowed (see Supreme Court Decisions 2001Du3228, Dec. 10, 2002; 2004Da8630, May 13, 2005, etc.).

Whether a medical care institution’s expenses are excessive charges for medical care institutions, and the relevant medical care institution’s expenses are determined based on the standards for medical care benefits and the standards for calculation of medical care benefits prescribed by Acts and subordinate statutes implemented at the time of receiving such expenses. Thus, whether a medical care institution’s expenses received in return for medical care constitute excessive charges pursuant to Article 43-2 (1) and (2) of the former National Health Insurance Act shall be determined based on the relevant Acts and subordinate statutes not on the amended medical care benefits standards, but on the basis of the standards for medical care benefits, etc. at the time of such medical care. Barring any special circumstance, the amended medical care institution’s Acts and subordinate statutes concerning the medical care benefits standards, etc.

In the same purport, the court below is just in holding that the above revised provisions cannot be applied retroactively to the inspection of the Daracs in the mountain of this case conducted before it was implemented on March 10, 2009 by the Ministry of Health, Welfare and Family Affairs No. 2009-45, which was amended by the Ministry of Health, Welfare and Family Affairs No. 2009-45 on March 10, 2009, which was based on delegation of Article 39(2) of the former National Health Insurance Act and Article 5(2) of the Regulations on the Standards for Medical Care Benefits, etc., and there is no error of law by misunderstanding the legal principles on the application of the amended

4. Conclusion

Therefore, the lower judgment is reversed, and the case is remanded to the lower court for further proceedings consistent with this Opinion. It is so decided as per Disposition by the assent of all participating Justices on the bench.

Justices Kim Yong-deok (Presiding Justice)