2026 Sickness Benefit Eligibility: Income Requirements, Payments, and Required Documents by Pilot Area

Sickness benefits provide a certain level of income replacement when an employed person stops working due to an illness or injury unrelated to work. In 2026, the program operates in Phase 2 and Phase 3 pilot areas, with the daily benefit amount and the sales recognition criteria for self-employed people adjusted from January.

Sickness benefits are not paid merely because someone has an illness. Eligibility is determined by reviewing all requirements, including the pilot area, age, employment status, income criteria, and whether the applicant actually stopped working. Before obtaining a medical certificate, it is therefore advisable to check eligibility and the application deadline with the National Health Insurance Service branch responsible for your area.

Differences Between 2026 Pilot Areas and Eligible Applicants

The biggest differences between Phase 2 and Phase 3 are whether household income and assets are assessed and how benefit amounts are calculated for some insured people.

Common Basic Requirements

In principle, employed people who meet the following conditions are eligible for assessment.

• At the time of application, reside in a Phase 2 or Phase 3 pilot area or work at an eligible workplace in that area
• Generally be an employed person aged at least 15 and less than 65
• Have a recognized employment status, such as an employee-insured National Health Insurance member, an Employment Insurance or Industrial Accident Compensation Insurance member, or a self-employed person who meets the requirements
• Be genuinely unable to work due to an illness or injury that is not work-related
• Stop working beyond the prescribed waiting period and experience a reduction in income

In some cases, eligibility may be recognized based on the location of the workplace rather than the applicant’s residence, and coverage for foreign nationals may vary depending on their status of stay and other factors. People covered by separate paid sick leave or income protection programs, such as public officials and teaching staff, and recipients of other benefits may be excluded or have their payments restricted.

Phase 2 Income and Asset Requirements

Phase 2 assesses applicants by household rather than looking only at individual income. Health insurance premiums paid by household members are used to determine whether household income is at most 120% of the median income, while asset criteria are also reviewed using the property tax base and other information.

Because the result may vary depending on household composition and how health insurance premiums are calculated, eligibility cannot be accurately determined simply by comparing monthly wages with a median income table. Additional documents concerning family relationships and health insurance eligibility may be requested during the application process.

No Income Restrictions in Phase 3

Phase 3 does not restrict applicants based on household income or assets. However, having no income restrictions does not mean that benefits are paid automatically. The pilot area, age, employment eligibility requirements, non-work-related illness or injury, work stoppage, and restrictions on overlapping benefits are assessed separately.

2026 Daily Benefit Amounts and Payment Periods

Phase 2 Benefit Amount

The 2026 Phase 2 sickness benefit is KRW 49,540 for each approved benefit day. The actual payment may differ from simply multiplying this amount by the total number of days the applicant did not work. The waiting period for each model is excluded from benefit days, and payment is made only for work-stoppage days or healthcare utilization days approved through the assessment.

Phase 3 Benefit Amount

For employee-insured National Health Insurance members in Phase 3, the amount is based on 60% of the calculated average wage. In 2026, the daily minimum is KRW 49,540 and the maximum is KRW 68,100, so payment cannot exceed the maximum even if the actual average wage is higher.

Employment Insurance or Industrial Accident Compensation Insurance members, self-employed people, and others who are not covered by the average-wage-linked calculation must check the fixed amount applicable to their eligibility category. If the employment relationship or insurance status changed immediately before the application, the amount is calculated based on the eligibility status confirmed by the National Health Insurance Service.

Waiting Period and Maximum Coverage Period

The pilot program includes a work-incapacity model that recognizes periods during which a person could not work because of illness and a model based on hospitalization and healthcare utilization days. The waiting period and annual maximum coverage period vary by regional model, and no benefit is paid for the waiting period.

The operating model and coverage period may be adjusted under the program guidelines for each year. Before applying, applicants should check the National Health Insurance Service’s 2026 regional guidance for the waiting period and maximum number of payment days applicable to their address.

What to Check Before Applying

If any of the following is unclear, it is advisable to contact the National Health Insurance Service before obtaining a medical certificate. This is because a fee for issuing a medical certificate specifically for a sickness benefit application may be charged separately from general medical expenses, and a standard medical certificate may not substitute for the designated certificate.

1. Confirm whether your residence or workplace meets the 2026 pilot area requirements.
2. Confirm whether you are recognized as employed based on your National Health Insurance, Employment Insurance, or Industrial Accident Compensation Insurance enrollment history or self-employment requirements.
3. Determine whether the illness or injury is unrelated to work.
4. Confirm whether the medical institution providing treatment participates in the sickness benefit program.
5. Confirm the application deadline, waiting period, and maximum coverage period applicable to your area.
6. Check whether you are receiving unemployment benefits, Industrial Accident Compensation Insurance temporary disability benefits, or other benefits for the same period.

For injuries or illnesses that occurred during work or have a substantial causal relationship with work, eligibility for Industrial Accident Compensation Insurance should be checked before applying for sickness benefits.

Application Process

1. Receive Treatment at a Participating Medical Institution

Find a medical institution participating in the sickness benefit program, receive treatment, and have a doctor determine whether the illness or injury prevents you from working. Under the work-incapacity model, a medical certificate specifically for a sickness benefit application is required rather than a standard medical certificate.

In areas where the healthcare utilization days model applies, medical records, hospitalization and discharge certificates, and other documents proving hospitalization and related healthcare utilization may be the primary documents. Applicants should therefore check the regional model first.

2. Complete a Work Stoppage Plan

Employees should complete a work stoppage plan after confirming with their employer the planned work stoppage period, work arrangement, whether wages will be paid, and other details. Special-type workers, platform workers, and self-employed people should prepare materials proving their contractual relationships and plans to suspend business activities.

Periods covered by paid sick leave or temporary closure allowances may be excluded from or adjusted against sickness benefit payment days, so whether wages were paid must be stated accurately.

3. Prepare Evidence of Eligibility, Employment, and Sales

Prepare employment and income documents appropriate for your type of work. Self-employed people must check the sales recognition criteria and the evidentiary period that apply from 2026. Employment status is not recognized solely based on business registration; evidence of actual business operations and sales may be required.

4. Apply to the National Health Insurance Service

Submit the documents to the National Health Insurance Service branch responsible for sickness benefit matters. If an online civil service application channel is available on the Service’s website, applicants may apply online. Confirm with the competent branch which other submission methods are permitted, such as in person, by mail, or by fax.

Sickness benefit applications may be submitted at any time throughout the year, but individual deadlines apply based on the date of the medical certificate or discharge. Under the work-incapacity model, applicants must apply within the prescribed period after the medical certificate is issued. Under the healthcare utilization days model, they must apply within the prescribed period after discharge. The deadline should therefore be confirmed as soon as the documents are issued.

5. Undergo Eligibility and Work Stoppage Assessment

The National Health Insurance Service verifies the area, age, insurance enrollment, income requirements, and medical condition. If necessary, it may additionally ask the workplace or applicant to verify whether the applicant actually worked and whether wages or sales were generated.

6. Receive Payment After Actual Work Stoppage Is Confirmed

The entire planned period is not automatically approved based solely on the initial application. After confirming that the applicant actually stopped working, the Service pays benefits for approved days excluding the waiting period. If treatment continues for an extended period, documents for an extension application may be required depending on the medical professional’s assessment and the program guidelines.

Required Documents by Type of Work

Specific forms and additional documents may vary by area and eligibility category. The table below summarizes the main documents to prepare.

Even if document names are similar, there may be separate forms specifically for sickness benefits. Applicants should use the latest forms published by the National Health Insurance Service and also check whether copies may be submitted and whether originals must be retained.

How Self-Employed People Can Prove Sales

Self-employed people are assessed on both the period during which their business registration has been maintained and whether they meet the actual sales requirements. Because the sales recognition criteria changed in 2026, the threshold amounts or evidentiary periods in older guidance must not be applied without adjustment.

Representative evidence of sales may include the following:

• Credit card or debit card sales slips or card company sales records
• Cash receipt issuance records
• Electronic tax invoices and invoices
• Sales deposit records from a business account
• Tax documents, such as a VAT tax base certificate

The Service determines employment status based on sales during the prescribed calculation period. If sales are seasonally concentrated due to the nature of the business or if the business conducts many cash transactions, applicants should first check with the competent branch which documents will be recognized.

Benefits Subject to Restrictions on Overlapping Support

Applicants cannot simultaneously receive the full amount of sickness benefits and other public benefits that compensate for the same work stoppage period. Representative benefits subject to restrictions include the following:

• Employment Insurance unemployment benefits
• Employment Insurance maternity leave benefits and childcare leave benefits
• Industrial Accident Compensation Insurance temporary disability benefits or injury and disease compensation pension
• National Basic Livelihood Security livelihood benefits
• Emergency welfare livelihood support
• Compensation for lost income paid by automobile insurance
• Separate paid sick leave or work suspension compensation paid by the government or an employer

The handling method may vary by benefit, including exclusion from eligibility, exclusion of payment for the same period, or adjustment of the difference. If applicants have applied for or are receiving another benefit, they must disclose it on the sickness benefit application and obtain a determination from the Service.

Final Checklist Before Applying

• I confirmed whether the applicable area is Anyang, Yongin, Dalseo-gu in Daegu, Iksan, Chungju, Hongseong, Jeonju, or Wonju.
• As a Phase 2 applicant, I checked the household income and asset requirements.
• As a Phase 3 applicant, I checked the employment and insurance eligibility requirements, which are separate from income restrictions.
• I checked the medical institutions participating in the sickness benefit program and the operating model for my area.
• I prepared a medical certificate for a sickness benefit application or hospitalization and discharge documents.
• I prepared a work stoppage plan and evidence of employment or sales.
• I confirmed the application deadline based on the date the medical certificate was issued or the date of discharge.
• I checked benefits that may overlap, including unemployment benefits, childcare leave benefits, Industrial Accident Compensation Insurance temporary disability benefits, and livelihood benefits.

There is no single year-round recruitment deadline for sickness benefits, but individual application deadlines may be short. Rather than waiting until after treatment begins to collect documents, it is important to check the procedure with the National Health Insurance Service customer center or the competent branch when you receive a diagnosis stating that you must stop working.