Tedious Health Insurance Claims? Now Easily Applicable!

In the future, health insurance policyholders will be able to claim insurance benefits without the hassle of obtaining cumbersome paper documents from hospitals. The "Simplified Health Insurance Claims Act," which streamlines the process of claiming expenses under health insurance policies, has been approved during the parliamentary session, and it is expected to result in billions of won in unclaimed benefits returning to policyholders every year.

 

An industry representative stated, "The Health Insurance Claims Automation Act, which is aimed at enhancing the convenience of the general public, has been approved 14 years after it was recommended by the National Human Rights Commission.

 

On the 6th of this month, the National Assembly convened its plenary session at 2 p.m. and approved amendments to certain sections of the Insurance Business Act. These amendments include provisions for insurance companies to delegate the processing of health insurance claims to specialized intermediaries, thereby automating the claims process. The automation of health insurance claims has been approved by the National Assembly after 14 years since it was recommended by the National Human Rights Commission in 2009.

 

To prepare for the automation of health insurance claims, tertiary healthcare institutions will have a one-year grace period, while primary care providers will have two years, meaning that health insurance claims automation will be fully implemented starting from the end of 2025.

 

This automation is expected to greatly enhance the convenience for health insurance policyholders. Currently, to claim health insurance benefits, one must visit hospitals or pharmacies after receiving medical treatment to obtain paper documents, and then submit these documents through insurance agents, insurers' fax machines, or apps. However, with the mandatory automation of health insurance claims, policyholders will only need to request the necessary medical records at the hospital, and the insurance benefits will be deposited directly into their bank accounts.

 

Now, there is no longer a need to give up on small health insurance claims due to the inconvenience of the process. Financial authorities and the insurance industry estimate that between 20 to 30 billion won in health insurance benefits go unclaimed every year. According to Yun Chang-hyun, a member of the ruling party, an estimated 2.76 trillion won in health insurance benefits remained unclaimed over the past three years.

 

However, the automation of health insurance claims will not happen immediately; it is expected to take about two years. To achieve health insurance claims automation, a standardized electronic information system needs to connect and operate among over 100,000 healthcare facilities, including hospitals and clinics, and 15 insurance companies.

 

Intermediary agencies will play a role in converting the medical records submitted by hospitals into electronic documents and providing them to insurance companies. Initially, the Health Insurance Review and Assessment Service (HIRA) was designated as the intermediary agency, but there is a higher likelihood that the Insurance Development Institute of Korea (IDIK) will assume this role due to opposition from the medical community.

 

The insurance industry, which has long awaited the automation of health insurance claims, welcomes the approval of these amendments. Initially, the bill was scheduled for discussion on the same day it passed the Legislation and Judiciary Committee of the National Assembly on the 21st of last month. However, it was postponed and further delayed when the plenary session did not convene on the 25th.

 

An industry representative stated, "The Health Insurance Claims Automation Act, which is aimed at enhancing the convenience of the general public, has been approved 14 years after it was recommended by the National Human Rights Commission. We hope that this automation will increase customer trust in the insurance industry."