Digitalization of Indemnity Claims: Clinics and Pharmacies at '3.3%' Participation... Government Offers Credit Guarantee Fee Incentives

Encouraging Participation from Medical Institutions and Consumers
Guarantee Fee Reductions for Medical Institutions
Enhanced Convenience for Consumers through Naver, Kakao, and Toss

The "digitalization of indemnity insurance claims," which allows users to conveniently file insurance claims through an application, is set to be implemented nationwide starting next month. However, the participation rate among clinics and pharmacies is only 3.3%. In response, the government will reduce the guarantee fee for loans backed by the Korea Credit Guarantee Fund for hospitals and pharmacies participating in the digitalization of claims by 0.2 percentage points for five years starting next year. Consumers will also be able to use the service through familiar apps such as Naver, Kakao, and Toss.

On September 5, the Financial Services Commission announced that it held a meeting of the legally mandated "Indemnity Insurance Digital System Operations Committee" at the Government Complex Seoul in Jongno-gu, Seoul, with representatives from the Ministry of Health and Welfare, the Financial Supervisory Service, the life and non-life insurance industries, the Korean Medical Association, the Korean Dental Association, the Association of Korean Medicine, the Korean Pharmaceutical Association, academia, and the legal community. The meeting discussed measures to increase the enrollment rate of medical institutions and other activation plans ahead of the expanded implementation of digital claims processing for clinics and pharmacies on October 25.

According to the Financial Services Commission, as of September 1, the number of medical institutions participating in claims digitalization stood at 7,801. The participation rate among first-tier institutions, such as hospitals and public health centers, is about 59.4%. The main issue is that the participation rate among second-tier institutions, such as clinics and pharmacies, is only 3.3%. Although participation from Korean medicine clinics and pharmacies has recently increased, the overall rate remains low.

The number of subscribers to the Silson24 service is 1.87 million, which is extremely small compared to the total 40.48 million indemnity insurance policyholders. Despite legal obligations, some electronic medical record (EMR) companies and medical institutions remain lukewarm about joining the digitalization of claims, citing a lack of financial incentive. There are also ongoing discussions between financial authorities, medical institutions, and EMR companies to find a compromise regarding commission payments and other issues.

The Financial Services Commission plans to expand incentives for medical institutions, EMR companies, and consumers, as well as strengthen public outreach. For hospitals and pharmacies that participate in digital claims processing by the end of next year, the guarantee fee for Korea Credit Guarantee Fund-backed loans will be reduced by 0.2 percentage points for five years from January 2026 to 2030. Starting in November, general insurance premiums for medical institutions participating in digital claims processing will be discounted by 3% to 5%. EMR systems participating in digitalization will be awarded a Silson24-linked certification mark to help improve marketing efficiency to medical institutions.

To enhance consumer convenience, the plan is to encourage consumers to directly request their medical institutions to connect to the digital claims system. To this end, Silson24 will be actively linked with online platform services. Consumers will be able to access digital claims services through Naver, Toss, Kakao, and other platforms. When making a hospital reservation on a platform, users will be supported in filing insurance claims immediately. Medical institutions connected to the digital claims system will be displayed on platform maps such as Naver Maps. If a patient pays medical fees using a registered payment method on a platform, an AlimTalk notification will be sent, guiding them to file their insurance claim digitally. For outpatient claims under 300,000 won that do not require review, Silson24 will ensure that insurance payments are made within 24 hours.

The Financial Services Commission announced that it is promoting Silson24 through various channels, including distributing YouTube videos about the service, advertisements on Naver, Kakao, and YouTube, pharmacy prescription bags, telemedicine apps, and online pharmaceutical malls. Advertisements for Silson24 are also being shown on each insurer's website and YouTube channel, and AlimTalk notifications are being sent to policyholders. Participation certification stickers and posters are being distributed to medical institutions participating in the digitalization of claims.

Ahn Chang-guk, Director General of the Financial Industry Bureau at the Financial Services Commission, emphasized, "Medical institutions must actively participate in the digitalization of claims to improve the convenience of insurance claims for the public, and we hope for the medical community's full cooperation. We will do our utmost to successfully implement the second phase of digitalization for clinics and pharmacies on October 25 and to set an exemplary case of collaboration between the government and the medical community."