Scheduled for the full meeting of the National Assembly's Political Affairs Committee on the 15th
Legislation and Judiciary Committee, enforcement upon plenary session approval
"Sufficient justification and public opinion"... Expectation for passage increases
The bill to simplify claims for indemnity health insurance, considered the "second health insurance," is increasingly likely to pass the National Assembly after 14 years. If passed, it will be possible to conveniently claim indemnity insurance benefits electronically without issuing various paper documents, regardless of which hospital the patient visits.
According to the industry on the 15th, the National Assembly's Political Affairs Committee is expected to hold a plenary session in the afternoon to discuss the "Amendment to the Insurance Business Act for Simplifying Indemnity Insurance Claims." If the amendment passes the plenary session, the remaining steps will be the Legislation and Judiciary Committee and the National Assembly plenary session. It is on the verge of passing 14 years after it was first proposed following the recommendation of the Anti-Corruption and Civil Rights Commission in 2009. Once the bill is implemented, consumers will no longer need to go through procedures such as obtaining various paper documents. After treatment, they only need to request the hospital, and the insurance claim will be automatically processed.
The industry is cautiously optimistic that the amendment will pass the plenary session. A positive public opinion has already formed under the justification of improving convenience for the public and preventing unnecessary paperwork. According to a 2021 survey conducted by the Green Consumer Network, Consumers Together, and the Financial Consumers Federation, 47.2% of indemnity insurance subscribers gave up on claiming insurance benefits due to reasons such as the small amount, failure to prepare various documents, or the hassle of submitting proof documents. A Financial Supervisory Service official explained, "The simplification of indemnity claims originally emerged within the Financial Supervisory Service as a system improvement measure to enhance consumer benefits," adding, "Since large and medium-sized hospitals, which most patients visit, have already participated for the convenience of financial consumers, the justification and public opinion are sufficient."
Although the medical community and some civic groups oppose the bill, they have not gained much support. They have opposed it on the grounds that medical information of indemnity insurance subscribers could be leaked through specialized intermediary agencies entrusted with the indemnity insurance claim process. In particular, the Health Insurance Review and Assessment Service (HIRA) strongly opposed becoming the intermediary agency, fearing that non-reimbursable treatment details at hospital and clinic levels would be transferred to HIRA. In this case, the government and insurance companies would be able to clearly identify and control non-reimbursable information.
In response to such opposition, the bill stipulates that the intermediary agency will be designated by a future presidential decree, with the Korea Insurance Development Institute being mentioned as a candidate. There is now little justification left for opposition. An insurance industry official pointed out, "If the government-controlled agency is not appointed as the intermediary agency in response to the medical community's opposition and instead a private entity takes on the role, not only insurance companies but also the medical community will have to bear the costs of building data transmission infrastructure," adding, "Also, by charging data relay fees, consumers, the medical community, and the insurance industry could all end up losing out."
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