Sharp Increase in Cataract Surgeries Covered by Indemnity Insurance... Revising Non-Covered Payment Standards

[Asia Economy Reporter Oh Hyung-gil] Financial authorities are revising the payment criteria for non-reimbursable items under indemnity health insurance, such as cataract surgery and orthotic treatment. They also plan to develop improvement measures for automobile insurance to prevent an increase in insurance premiums due to excessive medical practices.

Jung Eun-bo, Governor of the Financial Supervisory Service, stated at a meeting with CEOs of non-life insurance companies, "We will strengthen the social safety net function of insurance through improvements in indemnity insurance and automobile insurance systems."

He emphasized, "We will steadily implement comprehensive improvement measures for automobile insurance, including preventing excessive treatment of minor patients, to alleviate the insurance premium burden on the public." Regarding the 4th generation indemnity insurance introduced this year, the introduction of an online contract conversion system to enable consumers to easily subscribe is also under consideration.

So far, insurance companies have been strengthening their responses individually to prevent excessive treatment of non-reimbursable items, which are the main cause of deficits in indemnity insurance.

DB Insurance recently reported 43 ophthalmology clinics and hospitals to public health centers for illegal medical advertising, accusing them of false and exaggerated advertisements aimed at attracting cataract surgery patients. Hyundai Marine & Fire Insurance has consistently reported illegal medical advertising since 2019, with the number of cases reaching 344 to date.

The insurance industry is also strengthening joint responses. In September, five non-life insurance companies (Samsung Fire & Marine Insurance, DB Insurance, Hyundai Marine & Fire Insurance, KB Insurance, and Meritz Fire & Marine Insurance) reported five ophthalmology clinics located in Gangnam, Seoul, to the Fair Trade Commission for suspected violations of the Fair Trade Act due to excessive and illegal cataract treatments.

It is currently judged that excessive cataract treatment has increased to an uncontrollable level. Insurance payouts related to cataracts by 10 non-life insurance companies rose from 249 billion KRW in 2018 to 637.4 billion KRW last year, and in the first half of this year alone, they surged 58.2% compared to the same period last year to 481.3 billion KRW. It is highly likely to exceed 1 trillion KRW this year.

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