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(영문) 대법원 2018.11.15 2016다258209

부당이득금반환

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The appeal is dismissed.

The costs of appeal are assessed against the Plaintiff.

Reasons

The grounds of appeal are examined.

1.(a)

National Health Insurance System is a social insurance system that deals with social risks, such as illness and injury, arising to the people with the financial resources of insurance premiums paid by the insured and national treasury burden.

(Article 3 subparag. 2 of the Framework Act on Social Security). Therefore, the requirements for receiving national health insurance benefits, the scope of beneficiaries, the amount of benefits, etc. are specifically formed and determined in accordance with the law.

B. (1) Medical care benefits under the National Health Insurance Act are, in principle, benefits in kind are provided in kind, and insurance benefits are practically provided when the insured has received medical care in a medical care institution.

(see, e.g., Supreme Court Decision 2012Da39103, Sept. 13, 2012). National Health Insurance Act, etc. provides detailed procedures for providing health care benefit.

A policyholder or dependent who intends to receive medical care benefits (hereinafter referred to as "subscriber, etc.") shall apply for medical care benefits in submitting health insurance cards, etc. to a medical care institution.

(1) A health care institution, upon receiving an application for health care benefit, may request the National Health Insurance Corporation to pay health care benefit costs after providing health care benefit, such as diagnosis, examination, provision of medicine and materials for medical treatment, treatment, surgery, and other treatment, prevention, rehabilitation, hospitalization, nursing, and transfer of the insured, etc. with respect to the disease, injury, childbirth, etc. of the insured, etc., and then, may request the National Health Insurance Corporation to pay the health care benefit cost. However, the health care institution that intends to request the health care benefit

(Article 41(1) and 47(1) and (2) of the National Health Insurance Act. The National Health Insurance Corporation shall, upon receiving a notice of review from the Health Insurance Review and Assessment Service, pay the health care benefit to the health care institution without delay

(Article 47(3) of the National Health Insurance Act. On the other hand, a person who receives health care benefit shall bear expenses as prescribed by Presidential Decree.