"Even if you complete payments, you need to stay for 20 years"…You might lose real money just by paying premiums [Heotdari Economy]

(23) Compare Thoroughly and Consult Multiple Places

Editor's Note
It was thought to be a smart economic activity to gain something better, but often it turns out to be a misstep. When deceived by corporate marketing or blinded by momentary gains, making wrong decisions ultimately harms the consumer. We aim to examine economic activities where people have made mistakes by misjudging everyday situations.

"I paid diligently for 10 years, and now that I had surgery, I thought I would finally be covered."

Insurance prepared for unforeseen events. Even if you compare differences between insurance companies and carefully check the details, the thick terms and conditions and manuals, as thick as a book presented by an insurance agent, are difficult to understand. The same goes for explanations from insurance agents. In the end, despite diligent payments, situations arise where benefits are not paid when needed. Even if you cannot scrutinize every term and condition, you must be fully aware of the important details related to your insurance. The same terms can be interpreted differently by different hospitals, and insurance payouts can vary depending on the time of enrollment. This is why you need to revisit and carefully review the insurance you have already purchased.

Many Cases of Not Receiving Insurance Payouts

Ms. Yoon Seon-jin (40) recently canceled her life insurance policy that she had been paying for 10 years. She thought she would receive a maturity refund once the premium payments ended, but upon checking the insurance terms, she found this was not the case. Many people consider the end of premium payments as the maturity of the insurance, but often the maturity comes long after the payments are completed. Usually, the insurance maturity age can be set to 80 or 90 years old, and even if you receive a refund after fulfilling this period, considering changes in currency value, the amount is often considered small. For example, if you pay insurance premiums from age 30 to 60 and set the maturity at 80, you will receive the refund 20 years after completing payments.

Ms. Yoon said, "Considering the currency value, I judged that it was better to cancel even if it meant a loss," explaining her reason for cancellation. An insurance company official said, "'Expected maturity refund' exists, but the amount can vary, so the higher the coverage ratio, the less satisfying the amount received after maturity may be," adding, "Considering currency value, it may be advantageous for consumers to choose savings-type or policies with expiration features."

Ms. Han Eun-ji (34) contacted her insurance company to claim benefits after undergoing appendicitis (appendix) surgery but was told it did not apply. The insurance agent explained that it was outside the scope of the insurance rider. When enrolling in insurance, the coverage for 'specific surgery costs' is defined, and the diagnosis received during hospitalization is a crucial point. Coverage varies depending on whether the surgery was for illness, injury, or accident. Appendicitis falls under illness surgery costs, so those like Ms. Han who only have injury or accident surgery riders cannot receive insurance payouts.

Mr. Lee Myung-woo (43), who underwent laparoscopic surgery, also contacted his insurance company to claim benefits but was told it was not covered. The reason was the distinction between 'procedure' and 'surgery.' Some hospitals differentiate between surgery and procedures. Incision and cutting are considered surgery, but removing inflammation by injection is often regarded as part of a procedure. If you have insurance that only covers surgery costs, you will not be covered. For example, nerve block therapy is considered an injection treatment and surgery-related costs are not claimable. This is why it is important to check whether the surgery rider includes coverage for treatments like nerve block therapy. According to the Health Insurance Review & Assessment Service, to receive insurance benefits related to nerve block therapy, medical validity must be confirmed through medical records and imaging data.

Coverage May Vary Depending on Enrollment Time, So Verification Is Necessary

Even in cases of wound suturing, coverage may or may not be provided. Depending on the terms, surgery may be defined only if the wound reaches the muscle layer, or it may be considered surgery even if it does not. Regarding cancer insurance, thyroid cancer is classified as a minor cancer and is covered only about 10-20% compared to more fatal cancers. If thyroid cancer metastasizes and develops into a more fatal cancer, you need to check whether the rider includes metastatic cancer. If the primary cancer was thyroid cancer, there may be situations where coverage is not provided even if it metastasizes to other cancers.

Because insurance contracts are long-term, consumers should be aware that coverage criteria may change. A Hanwha Life official said, "Even if you subscribe to insurance with the same name and undergo the same surgery, the coverage range of insurance payouts may differ depending on the type of rider at the time of enrollment." They added, "You should be well aware of your own insurance," and explained, "If it is difficult to review the terms, it is good to inquire at the call center and at least check the summary of the policy document."

Although complicated and cumbersome, you must understand the meanings of terms specified in the policy and know the differences. Park Sang-jin, an insurance planner at Ez Financial Services, advised, "Even if it is stated on the insurance certificate, the terms in the policy may differ, causing confusion for consumers," and recommended, "Because insurance is complex, do not just trust acquaintances; it is better to compare and consult thoroughly before enrolling."