Simplification of Actual Expense Claims Passes National Assembly Threshold After 14 Years... Intermediary Institutions Still Pending

Immediate Insurance Claim Possible After Medical Treatment

A bill allowing the simplified electronic claim of indemnity medical insurance benefits has passed the National Assembly floor for the first time in 14 years. Conscious of the medical community's fierce opposition, the intermediary agency for claim information will not be fixed as the Health Insurance Review & Assessment Service but will be determined later by a presidential decree.

On the 16th, the National Assembly's Political Affairs Committee's 1st Subcommittee on Bill Review approved the amendment to the Insurance Business Act to simplify indemnity medical insurance claims. This is the first time in 14 years since the recommendation by the Anti-Corruption and Civil Rights Commission in 2009 that the bill has passed the hurdle. It is expected to go through the full Political Affairs Committee meeting, the Legislation and Judiciary Committee, and the plenary session of the National Assembly before final approval.

Once the bill is enacted, consumers will be able to claim indemnity insurance benefits simply by requesting it at the hospital after treatment without going through complicated procedures. This is because hospitals will be able to send various documents to insurance companies through specialized intermediary agencies on behalf of consumers. Until now, consumers had to obtain paper documents of non-reimbursed treatment histories and send them again by fax, an unnecessary process. Insurance companies also repeatedly entered the received paper documents into their systems and processed the payment of insurance benefits.

However, the medical data transmission intermediary agency remains undecided. It will be determined later by a presidential decree. Although the Health Insurance Review & Assessment Service was discussed, the discussions were repeatedly canceled due to fierce opposition from the medical community. The reason is that if non-reimbursed treatment details from hospitals and clinics are transferred to the Health Insurance Review & Assessment Service, the government and insurance companies could control related costs. The Korea Insurance Development Institute is being considered as an alternative agency.