'Simplification of Actual Loss Insurance Claims' Fails Again This Year... Consumer Inconvenience Ignored

Insurance Business Act Amendment Drifts for 12 Years
Some Lawmakers Show Caution Amid Medical Community Opposition

[Asia Economy Reporter Oh Hyung-gil] A bill to simplify the claims procedure for indemnity health insurance, which has 38 million subscribers and is called the "second health insurance," was not discussed again this year. With no progress in the National Assembly discussions for over 12 years, some lawmakers have faced criticism for ignoring consumer inconvenience while being cautious of the medical community.

According to the National Assembly and the insurance industry on the 23rd, the first subcommittee on bill examination of the National Assembly's Political Affairs Committee did not discuss the amendment to the Insurance Business Act containing the simplification of indemnity insurance claims. A Political Affairs Committee official said, "Since the medical community, which can be considered a stakeholder, opposes it, the discussion did not proceed due to the need for time to persuade them."

In the 21st National Assembly, five bills including those proposed by Democratic Party lawmakers Ko Yong-jin, Jeon Jae-su, Kim Byung-wook, Jeong Cheong-rae, and People Power Party lawmaker Yoon Chang-hyun were submitted to simplify indemnity insurance claims.

The simplification of indemnity insurance claims centers on replacing paper documents required for insurance claims with electronic documents. When an insured person requests related materials from a medical institution to receive insurance benefits, the medical institution sends the data through a network to the Health Insurance Review and Assessment Service (HIRA) or a third party, which then forwards it to the insurance company.

This system allows patients to submit documents without visiting medical institutions or insurance companies, enabling automatic insurance claim and payment processing. Medical institutions can also reduce administrative costs related to issuing unnecessary documents. Currently, hundreds of millions of paper documents are wasted annually.

In particular, most indemnity insurance subscribers give up on claiming insurance benefits due to the cumbersome claim procedures. According to a survey conducted by consumer groups including Consumers Together on 1,000 people aged 20 or older who subscribed to indemnity insurance in the past two years, 47.2% of respondents reported having experience giving up on indemnity insurance claims.

Last year, out of a total of 79,444,000 indemnity insurance claims filed with non-life insurance companies, only 91,000 claims (0.11%) were submitted electronically.

However, the medical community opposes forcing medical institutions, rather than the parties to the insurance contract, to submit documents, arguing it is unreasonable and that sensitive patient medical information could be leaked. In particular, there is concern that since HIRA can review non-reimbursable items, it may strengthen control over medical institutions in the future, reducing their revenue.

An insurance industry official said, "Even now, patients submit medical information to insurance companies, and digitization does not change the content of medical information, but the medical community opposes it because of non-reimbursable items," adding, "Control over non-reimbursable items is directly linked to medical institutions' revenue, so they seem to be opposing it desperately."

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