Health Insurance Copay Calculator
Last updated: 2026-06-25
Your health insurance (silson) copay is the larger of (cost × copay rate by generation, e.g. 20% covered / 30% non-covered for 4th-gen) and the minimum deductible for the visit type. The cost minus the copay is your estimated reimbursement.
Reimbursement = (covered cost − covered copay) + (non-covered cost − non-covered copay). This result is an estimate for reference only.
Enter medical costs
Estimated reimbursement
₩0
| Type | Cost | Copay | Reimbursement |
|---|---|---|---|
| Covered | |||
| Non-covered | |||
| Total |
Copay rates by generation and minimum deductibles are representative values and vary by product and rider. Exact reimbursement follows your insurer's terms and claim review. This result is an estimate for reference only.
How to use
- Select visit type and generation — choose outpatient or inpatient, and pick your silson generation (1st–4th).
- Enter medical costs — enter the covered out-of-pocket amount and the non-covered cost separately, in won.
- View the result — press calculate to see the copay and estimated reimbursement for covered and non-covered care, plus totals, in a table.
How health insurance copay is calculated
Korean health insurance (silson) reimburses the medical costs you actually paid, but the policyholder also pays a share through a copay. The copay is the larger of two amounts: first, the cost multiplied by the copay rate; second, the minimum deductible for an outpatient visit. So when the bill is small the minimum deductible applies, and when the bill is large the copay-rate amount applies.
| Generation | Covered copay rate | Non-covered copay rate |
|---|---|---|
| 1st gen (before 2009) | 0% | 0% |
| 2nd gen (2009–2017) | 10% | 20% |
| 3rd gen (2017–2021) | 10% | 20% |
| 4th gen (since July 2021) | 20% | 30% |
Outpatient visits apply a minimum deductible by facility type. Typically clinics/hospitals deduct ₩10,000 covered, general hospitals ₩15,000, and tertiary hospitals ₩20,000, while non-covered care deducts ₩30,000. Inpatient care usually applies only the copay rate without a minimum deductible, within an annual out-of-pocket cap (e.g. ₩2,000,000). This calculator uses representative values and does not factor in annual caps, visit-count limits, or exclusions, so it may differ from your actual reimbursement.
To learn more about covered vs. non-covered care and copay rates, see the Understanding Health Insurance Copay guide.
Frequently asked questions (FAQ)
What is a health insurance copay?
The copay is the share of a medical bill that the policyholder pays out of pocket and the insurer does not reimburse. It is the larger of (cost × copay rate, e.g. 20% covered / 30% non-covered for 4th-generation plans) and the minimum deductible for the visit type. The cost minus the copay is the reimbursement.
What is the difference between covered and non-covered care?
Covered care is eligible for national health insurance and refers to the patient out-of-pocket amount on your bill. Non-covered care is not eligible for national health insurance and is paid fully out of pocket (manual therapy, some MRIs, non-covered injections, etc.). 4th-generation silson applies different copay rates to covered and non-covered care, so they are calculated separately.
How do copay rates differ by generation?
1st generation (before 2009) has little or no copay, 2nd generation is typically 10–20%, 3rd generation is 10% covered / 20% non-covered (30% on riders), and 4th generation (since July 2021) is typically 20% covered / 30% non-covered. This calculator uses representative values per generation, so check your own policy for the exact rates.
What is the minimum deductible (minimum copay)?
For outpatient visits, a minimum amount is always deducted (e.g. ₩10,000 at a clinic/hospital, ₩15,000 at a general hospital, ₩20,000 at a tertiary hospital, ₩30,000 for non-covered care). If the copay-rate amount is smaller than this, the minimum deductible applies. Inpatient care usually applies only the copay rate, within an annual cap (e.g. ₩2,000,000).
Is this result the same as my actual reimbursement?
No, it is an estimate for reference. Actual reimbursement depends on your enrollment date, generation, riders, number of visits, annual caps, exclusions, and more. The exact amount follows your insurer's terms and claim review.
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Last updated: 2026-06-25