Re-registration for Special Calculation Exemption Eased for Rare and Severe Intractable Diseases... Diagnostic Test Burden Reduced for 95 Conditions

NHIS Expands Re-registration Eligibility Based on Clinical Diagnosis and Treatment History
Coverage Extended to 95 Diseases Including Kennedy's Disease; 146 More to Be Improved Next Year

The number of diagnostic tests required for patients with rare and severe intractable diseases during the process of re-registering for the special calculation exemption has been significantly reduced.

The National Health Insurance Service announced on September 14 that, effective from the 15th, it will improve the criteria for re-registration under the special calculation exemption for rare and severe intractable diseases and expand its application to 95 diseases.

The special calculation exemption is a system designed to reduce the high medical expenses for patients diagnosed with cancer, rare diseases, and severe intractable diseases. For rare and severe intractable diseases, the exemption typically applies for five years upon registration. If the disease persists and ongoing treatment is required after this period, patients can apply for re-registration. The copayment rate for patients with rare diseases is 10%, and for those with severe intractable diseases, it is also 10%.

Previously, to re-register after the five-year exemption period had ended, patients had to submit clinical diagnoses and diagnostic test results according to disease-specific criteria. However, due to the nature of rare and severe intractable diseases, which are difficult to cure, patients often had to undergo repeated tests for re-registration even when their condition could already be clearly identified through clinical diagnosis.

To address this issue, the National Health Insurance Service has updated its criteria so that if a patient's condition can be clearly confirmed through clinical diagnosis, re-registration can be completed without additional test results. In necessary cases, a review of treatment history may be required.

This latest improvement applies to a total of 95 diseases, including 58 rare diseases, 32 ultra-rare diseases, and 5 severe intractable diseases. For example, in the case of Kennedy's disease, previous re-registration required genetic testing, electromyography, and nerve conduction studies; however, in the future, re-registration will be possible based solely on a clinical diagnosis without additional tests. Kennedy's disease is a progressive neuromuscular disorder that develops in adulthood, gradually damaging motor nerves and muscles.

Since January this year, the National Health Insurance Service has already eased the re-registration criteria for 9 rare diseases, including Charcot-Marie-Tooth disease, on a priority basis, and this scope has now been expanded to 95 diseases. Next year, the Service also plans to further improve the re-registration criteria for 146 diseases, including Nezelof syndrome, which currently require test results for re-registration.

Kang Cheonghee, President of the National Health Insurance Service, stated, "By streamlining the special calculation exemption re-registration procedure, we have reduced the burden of diagnostic tests for rare and severe intractable disease patients and enabled them to receive the necessary treatment and management in a more stable manner." He added, "We will continue to promote the expansion of coverage that delivers tangible benefits to people’s lives."

This content was produced with the assistance of AI translation services.