# Covered or non-covered self-check

> This self-check sorts care into three broad outcomes using a short rule list drawn from Korea’s health insurance law.

It never gives a final decision; the institution confirms coverage for your diagnosis.

Written by the Korea Non-covered Medical Price Statistics editorial team on October 21, 2026. Canonical address: https://kmedprice.org/tools/coverage-check.

## What rules does this self-check apply?

Rules are checked from the top and the first match decides the outcome.

**Self-check rules (summary of legal provisions)**

| Condition | Outcome | Basis |
| --- | --- | --- |
| Not enrolled in health insurance | Likely non-covered | National Health Insurance Act |
| Cosmetic purpose | Likely non-covered | Benefit standards rules, Annex 2 |
| Inpatient amenity such as room upgrade | Case by case | Benefit standards rules, Annex 2 |
| Preventive purpose | Case by case | Benefit standards rules, Annex 2 |
| Examination or treatment for an illness | Likely covered (limits apply) | Benefit standards rules |
| Procedure for an illness | Case by case | Selective benefit notice |
| Anything else | Case by case | Benefit standards rules |

## What do typical answers return?

Three fixed examples are tested on every build.

**Fixed test cases checked on every build**

| Selection | What the tool shows |
| --- | --- |
| Examination · illness · insured | likely covered, but some items have frequency limits |
| Procedure · cosmetic · insured | likely non-covered |
| Inpatient amenity (room upgrade) · illness · insured | case by case (room grade rules) |

## Why only three outcomes?

Coverage depends on the diagnosis and detailed criteria, so a short self-check can only point in a direction.

Korea Non-covered Medical Price Statistics shows the distribution of prices disclosed to HIRA, not the price at any particular institution, and it introduces or recommends no hospital. The relationship between price and treatment results cannot be judged from this data. Disclosed prices can differ from the amount actually billed. For a specific institution, use HIRA’s official non-covered price service.

## What basis are these numbers on?

| Data | Reference date | Site calculation |
| --- | --- | --- |
| Coverage self-check rules | To be filled after the reference date is confirmed | First matching rule; result limited to three categories |

## What else do people ask about coverage self-check?

### Is my treatment covered by Korean health insurance?

The self-check gives a direction only. The institution confirms coverage for your diagnosis.

### I am a foreign visitor without Korean insurance. What applies?

Insurance benefits do not apply, so you are generally charged the full amount; travel insurance terms vary.

### What is a selective benefit?

Care covered by insurance with a higher co-payment share than regular benefits.

### Are my answers stored?

No. The classification runs in your browser.

### Why does an examination for illness say “limits apply”?

Items such as ultrasound and MRI are covered only within set indications and frequency limits.

## What should you read next?

- [What is “non-covered” in Korea’s insurance system?](https://kmedprice.org/articles/what-is-non-covered)
- [How do you read a Korean medical receipt?](https://kmedprice.org/articles/read-medical-receipt)
- [Non-covered share of medical spending](https://kmedprice.org/statistics/share-of-spending)
- [Manual Therapy prices in Korea](https://kmedprice.org/statistics/manual-therapy)

## Where do these numbers come from?

- [National Health Insurance Act](https://www.law.go.kr/법령/국민건강보험법) - Korea Law Information Center
- [Rules on the Standards for National Health Insurance Care Benefits (Annex 2: non-covered items)](https://www.law.go.kr/법령/국민건강보험요양급여의기준에관한규칙) - Korea Law Information Center
- [Standards for designation and implementation of selective benefits (notice)](https://www.law.go.kr/행정규칙/선별급여지정및실시등에관한기준) - Ministry of Health and Welfare (Korea Law Information Center)