'35 Million Enrolled' Real-Expense Insurance... 760,000 People Claimed 10 Million Won

"Overall Insurance Premiums Rise Due to Excessive Medical Use by a Minority"

[Asia Economy Reporter Oh Hyung-gil] Last year, 760,000 people received insurance payouts exceeding 10 million won through indemnity health insurance. This accounts for only 2% of the total 35 million subscribers.

Behind the insurance companies' multi-trillion won annual deficits from indemnity insurance lies a concentration phenomenon where a small number of subscribers with high medical usage dominate.

According to the insurance industry on the 9th, among the 34.96 million indemnity insurance subscribers last year, 760,000 received insurance payouts exceeding 10 million won. The number of subscribers receiving payouts exceeding 50 million won also reached 90,000.

The number of subscribers who received insurance payouts even once was 1.31 million, accounting for 37.6% of the total, and they received 58.4% of the total insurance payouts.

On the other hand, about 60% of subscribers were found to have never used indemnity insurance even once. These subscribers paid their premiums regularly every month but did not receive any insurance payouts.

The deficit in indemnity insurance continues to accumulate. Last year, the insurance profit and loss (premium income - insurance payouts - operating expenses) for personal indemnity insurance, including elderly and chronically ill indemnity, was a deficit of 2.5 trillion won according to the Financial Supervisory Service.

Ultimately, the insurance industry's assessment is that the reason for the continued deficit despite the low utilization rate of indemnity insurance among the entire subscriber base is excessive medical use by a small number of subscribers. Non-reimbursed treatments such as multifocal cataract surgery, manual therapy, and vitamin/nutrient injections, which are not covered by health insurance, are seen as the main causes of the deficit.

Additionally, even when indemnity insurance subscribers use medical institutions, the complicated claim procedures?such as having to obtain related documents to file a claim?are also considered a reason why many do not file claims.

Insurance companies are raising premiums to recover losses. This year, premiums for the old indemnity insurance (sold before September 2009) were increased by 6.8?21.2%, and premiums for standardized indemnity insurance (sold from October 2009 to March 2017) were also raised by 6.8?21.2%, but the deficit appears to be growing instead.

As of the end of June this year, the indemnity insurance profit and loss in the non-life insurance industry showed a deficit of 1.4128 trillion won, and the deficit is expected to reach 3 trillion won by the end of the year.

An insurance industry official said, "The basic principle of insurance is to have everyone pay a small share and help those who suffer unexpected misfortunes, but the structure of indemnity insurance is excessively unsustainable," adding, "Managing non-reimbursed treatments to curb overmedicalization is urgently needed."

This content was produced with the assistance of AI translation services.