When do you need a referral letter in Korea?
The line is not hospital size but whether the institution is a tertiary hospital. Without a referral you are not turned away — you pay the entire bill yourself.
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A referral letter is the document a lower-tier institution issues so that health insurance will apply at a tertiary hospital.
The line is the tertiary tier, not size
Insurance-covered care is split into two stages (Rule on the Standards for Health Insurance Benefits, Article 2).
| Stage | Institutions | Referral |
|---|---|---|
| First stage | Every institution except tertiary hospitals (general hospitals, hospitals, clinics) | Not needed |
| Second stage | Tertiary hospitals | Needed |
This is where people usually go wrong. A big hospital does not automatically require a referral. A general hospital is first-stage and takes walk-ins; only tertiary hospitals sit behind the referral requirement.
For second-stage care you must present either the referral form (prescribed Form 4) or a health examination result carrying a doctor’s opinion that tertiary care is needed, together with your insurance card or photo ID.
The seven exceptions
Article 2(3) of the same rule lists seven situations where you may receive first-stage care directly at a tertiary hospital.
| Exception | Condition |
|---|---|
| Emergency patient | As defined in the Emergency Medical Service Act |
| Childbirth | — |
| Dentistry | Only for care received in the dental department |
| Rehabilitation medicine | Registered disabled persons, or those needing rehabilitation beyond simple physiotherapy — only in the rehabilitation medicine department |
| Family medicine | Only for care received in that department |
| Institution’s own staff | Insured persons working at that institution |
| Hemophilia patients | — |
The disability exception is the most widely misunderstood. Being a registered disabled person is not itself a blanket exemption — it applies only to rehabilitation medicine. Dentistry and family medicine are likewise limited to care in those departments.
What happens if you go without one
You are not turned away. Article 15(1) of the Medical Service Act prohibits refusing treatment without justification, and a missing referral is a coverage question, not grounds for refusal.
Instead you pay the whole bill. Schedule 6 of the Enforcement Rule of the National Health Insurance Act treats the total cost as patient-borne when the benefit procedure is not followed, at a rate of 100 percent of the covered care cost.
There is a second disadvantage. That full self-paid amount is excluded from the annual out-of-pocket ceiling, so it does not count toward any refund you might otherwise expect in a high-cost year.
Why the system exists
It is a tiered delivery mechanism meant to stop mild cases from crowding large hospitals so severe cases can be seen in time. Which institutions hold tertiary status changes every three years — see how institutions are tiered.
Sources: Rule on the Standards for Health Insurance Benefits Article 2; Enforcement Rule of the National Health Insurance Act Schedule 6; Medical Service Act Article 15. Last checked 2026-08-30.
Frequently asked questions
Do I need a referral for a general hospital?
No. Only tertiary hospitals require one. General hospitals, hospitals and clinics are all first-stage care, so you can walk in.
Will a tertiary hospital refuse to see me without a referral?
No. You can be treated, but health insurance will not apply and you pay the full cost. That amount is also excluded from the annual out-of-pocket ceiling calculation.
Are there exceptions?
Seven. Emergency patients, childbirth, dentistry, rehabilitation medicine for registered disabled patients, family medicine, employees of that institution, and hemophilia patients.