[Who the hell?] Have you ever used indemnity insurance like this?
#One. Deputy head of office worker A who receives vitamin injections once or twice a week to relieve a hangover. I use it often because it seems to relieve my hangover and my skin seems to be getting better at the same time. You have to pay more than 10,000 won each time, but it is not burdensome. Because disability insurance covers it all. There are various hospitals that can receive fluid treatment. The orthopedic surgery, otolaryngology department, family medicine department, and hospital in front of the company actively recommend fluid therapy. If you have actual loss insurance, you can submit the doctor's written opinion and the detailed receipt for medical expenses to the insurance company's application and get a 100% refund of the hospital expenses.
#2. Group C, a 15-year-old middle school student, has received manual therapy 122 times in the past three years. The cost of treatment is $2,800,000. However, thanks to the indemnity insurance, group C does not actually spend any money. Manual therapy is a treatment for people with musculoskeletal disorders, but group C has no related disorders. He received treatment because he was told that if he received manual therapy, he would grow taller and his body shape would be corrected.
#3. Housewife D, who visits an orthopedic surgeon who is good at treating skin diseases. The doctor first asks if you want to purchase indemnity insurance. Let's say you are insured for loss of life insurance, we recommend an expensive lotion. I bought 10 lotions and paid about 300,000 won. However, when I submitted the doctor's written opinion and documents, more than 90% of the amount I paid was returned.
This is a real case.
The number of people who actively use the indemnity insurance in this way is about 10% of the total indemnity insurance subscribers.
These people took more than half of the total insurance money.
Its size is also increasing every year.
However, as subscribers with high or low insurance pay the same premium, critics have continued to point out that it is excessive treatment or excessive consumption of medical care.
As a result, the indemnity insurance system is drastically changed.
[What is that?] 'Indemnity insurance', what is it?
Of the 51 million Koreans, 39 million are enrolled in 'Medical Indemnity Insurance'.
Since more than 75% of the total population has signed up, it deserves to be called the 'second health insurance'.
It is called 'indemnity insurance' because it guarantees the actual money paid when the insured receives treatment for illness or injury.
Compensation for medical and pharmaceutical expenses actually incurred in hospitals or pharmacies.
It is also called 'Medical Actual Expense Insurance' because the insurer actually pays the actual cost.
The original cost of 'non-insurance' treatment, which is not covered by health insurance, should be borne by the patient 100% of the time, but indemnity insurance covers this part.
Indemnity insurance, which was first sold in September 1999, is divided into 1st to 4th generation medical insurance according to the sales period or collateral composition.
Click ▶ Characteristics of Indemnity Insurance by Generation
Indemnity insurance was first introduced by Samsung Fire & Marine in 1999.
Since then, other insurance companies have followed suit, with virtually no co-payments and a wide coverage.
This is the first-generation indemnity insurance sold until October 2009.
At that time, each company had different limits, deductibles, and guarantees.
In 2009, indemnity insurance, which was different for each life insurer and non-life insurer, was standardized under the supervision of the Financial Supervisory Service.
For this reason, the second-generation indemnity insurance sold since October 2009 is also called 'standardized indemnity insurance'.
Second-generation indemnity insurance subscribers account for nearly 50% of the total insured.
The out-of-pocket cost for second-generation indemnity insurance is 10-20%.
For example, out of the 100,000 won treatment cost after receiving manual therapy, the co-pay is 10,000 won.
The remaining 90,000 won is paid by the indemnity insurance.
The insurance premium renewal cycle has also been reduced from 3-5 years for the first generation to 1-3 years.
As the insurer's deficit increased as subscribers' medical use increased, the financial authorities allowed the launch of third-generation indemnity insurance in April 2017.
The 'self-pay' that patients have to pay has been increased.
For example, if you receive 100,000 won uninsured treatment, first-generation indemnity insurance subscribers only need to pay 0 won, second-generation indemnity insurance subscribers only need to pay 10,000 won, but third-generation indemnity insurance subscribers have to pay 20,000 to 30,000 won. do.
It is also called 'good indemnity insurance' as the subscriber's premium has been reduced by about 35% at the time of launch as the subscriber's deductible has increased.
[Why are you doing this?] Two reasons why indemnity insurance keeps changing
There are two main reasons why indemnity insurance keeps changing.
The first is the accumulated deficit of indemnity insurance.
Indemnity insurance has been in the red for five consecutive years since 2016.
According to the Financial Supervisory Service, there was a loss of 2.5 trillion won in indemnity insurance last year alone.
To make up for this deficit, insurers raise premiums from insurers.
The second is the insured's need to maintain insurance.
Indemnity insurance is necessary, but the insured who cannot afford the rising premium every time it renews is trying to switch to next-generation insurance, which is cheaper even if the coverage is reduced.
The reason insurance premiums continue to rise is that a small percentage of indemnity insurance subscribers receive excessive treatment and receive most of the indemnity insurance premiums.
The premiums for many people who do not use insurance are also rising.
The premium for first-generation indemnity insurance, which can receive uninsured medical treatment without co-payment, has increased by around 20% for two consecutive years.
This happened as the insurance industry had to block people who received excessive treatment, but it was not easy to do so, so the loss was compensated by raising the overall premium.
The financial authorities envisioned the 4th generation indemnity insurance to solve the accumulated loss of indemnity insurance and the steep rise in premiums.
The insurance industry started selling fourth-generation indemnity insurance from this month.
[What's going on?] 4th generation indemnity insurance "If you go to the hospital often, you pay a lot"
The key to 4G indemnity insurance is simple.
“If you go to the hospital often, you pay a lot.” The
4th generation indemnity insurance, which started selling in July 2021, reduces the monthly payment compared to the existing 1st, 2nd, and 3rd generation indemnity insurance, and increases the 'self-pay' paid by patients when receiving treatment .
While the previous generation's indemnity insurance covered both paid and non-indemnity treatment, the 4th generation separated benefit and non-wage treatment.
Non-reimbursement items are separated into 'special contracts'.
In the future, you must sign up for a special contract to receive non-insurance items.
When the indemnity insurance policyholder receives treatment at the hospital, he or she will receive an amount from the insurance company after deducting the 'co-payment' from the amount billed by the hospital, and this self-pay ratio increased from the first to the third generation.
Currently, the self-pay, which is 10-20% for salary items and 20% for non-pay items, increases by 10% more in the 4th generation indemnity insurance.
Even if insurance is processed, the 'minimum deductible' that the insured must pay will also increase.
Salary items will be raised to at least 10,000 won for hospitals and clinics, 20,000 won for tertiary and general hospitals, and at least 30,000 won for non-insured items.
However, the basic insurance premium itself will go down.
Compared to the first-generation insurance premiums of 40,000 won per month, the first-generation insurance premium fell to 10,000 won from the third-generation, and the fourth-generation became cheaper.
Just as car insurance premiums are increased if you have a lot of car accidents, premiums are applied to the 4th generation indemnity insurance.
Depending on the amount of uninsured medical use in the previous year, the premium may be higher, or conversely, a discount may be given.
[What's the problem?] Insurance companies raising the threshold for subscription
“If you have been to a hospital even once in two years, you cannot purchase indemnity insurance.” This
is the 4th generation indemnity insurance policy suggested by some insurance companies.
In 2010 alone, 30 companies sold indemnity insurance, but only 15 companies, half of the 4th generation, decided to sell.
The reason why the number of participating companies is so low is because of the huge deficit in indemnity insurance.
However, insurance companies that have launched have set strict conditions for subscription.
Kyobo Life and Hanwha Life Insurance cannot join if they have received hospital treatment within two years, and Samsung Fire & Marine Insurance prohibits new subscriptions if the amount of insurance paid for diagnosis and surgery in the past two years exceeds 500,000 won.
As the threshold for 4th generation indemnity insurance increased, the Financial Supervisory Service recently notified the insurance industry to 'prepare reasonable grounds and specific criteria for subscription'.
Regarding this, the insurance industry expressed discomfort, saying, "It is the company's autonomous decision to set the insurance subscription criteria."
Some argue that if the authorities do this, insurance companies will have no choice but to stop selling indemnity insurance.
There is currently no objective judgment manual to determine whether the membership criteria are reasonable or not.
As there are no sharp measures to reduce the loss ratio of the insurance industry, the conflict between the authorities and insurance companies is expected to continue for the time being.
[What should I do?] 'Do you change or drink?' Your choice?
The key is your current health status and how likely you are to go to the hospital in the future. In most cases, experts analyze that it would be advantageous to not change and maintain the existing indemnity insurance. The Financial Consumers' Federation, a financial consumer group, argued that "in the case of the old indemnity insurance, premiums are rising sharply every time the contract is renewed, but it is necessary to be cautious about switching to the 4th generation indemnity insurance." This means that it is better for insurers who need regular hospital treatment due to illness to keep their existing insurance even if the renewal insurance premium is paid.
In the case of 1st and 2nd generation loss, there is no or low self-pay, and the renewal cycle is long. Therefore, it is advantageous to maintain the existing indemnity insurance if it is likely that the hospital will be used frequently. However, it is necessary to take into account the fact that insurance premiums continue to rise in the case of old loss due to the product structure.
If you rarely go to the hospital and the monthly premium is a burden, it is advantageous to switch to the 4th generation indemnity insurance. In particular, there is an analysis that it would be beneficial for young people in their 20s and 30s who do not use hospitals often and have to pay insurance premiums for a long time to come, to switch to the 4th generation indemnity insurance. Coverage of non-indemnity items such as manual treatment and nutritional supplements decreased, but coverage of benefit items such as infertility and infertility treatment and congenital brain disease was expanded. In addition, among skin diseases such as acne, benefits that require treatment are covered by the indemnity insurance. If you need related treatment, the 4th generation indemnity insurance is more advantageous.
(Composition: Senior Correspondent Lee Hyun-sik, Reporter Jang Seon-i, Kim Hwi-ran Editor / Design: Myung Ha-eun, Lee Ji-soo)