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(영문) 대법원 2013.03.28 2008두19338
진료비삭감처분등취소
Text

Of the part against the plaintiff in the judgment of the court below, the calculation of the calculation of the refund amount of the attached medical expenses shall also be made separately.

Reasons

We examine the grounds of appeal.

1. (1) According to Articles 41 and 43-2 of the former National Health Insurance Act (amended by Act No. 7347 of Jan. 27, 2005), a policyholder of the National Health Insurance or his/her dependent (hereinafter “subscriber, etc.”) may request the Defendant to verify whether the expenses incurred in addition to the amount of co-payment to be borne by himself/herself as prescribed by Presidential Decree, among the costs of health care benefit, are excluded from the amount of health care benefit under Article 39(3). Upon receipt of such request, the Defendant shall notify the relevant health care institution of the details of the request when the expenses requested for verification are confirmed to constitute the amount of expenses incurred in relation to the subject of health care benefit, and the health care institution so notified shall, without delay, pay the amount collected excessively (hereinafter

In full view of the purpose of the national health insurance system and the structure of the National Health Insurance Decree, including the subject matter of health care benefit, the standards and procedures for payment of expenses, and the legal principle on non-benefit objects, etc., a health care institution, in principle, provides health care benefit in accordance with the standards and procedures prescribed in the statutes on the standards for recognition of health care benefit, unless the so-called non-benefit treatment is the one excluded from the subject matter of health care benefit under Article 39(3) of the former National Health Insurance Act, and the payment of health care benefit is made by insurers, subscribers, etc. (see Supreme Court en banc Decision 2010Du27639, 2010Du27646, Jun. 18, 2012). Therefore, the Defendant provided health care benefit to subscribers, etc. in accordance with the standards and procedures prescribed in the statutes on the standards for recognition of health care benefit.

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