Insurance Premium Reimbursement Debate Resumes
- South Korea's insurance sector is closely monitoring revisions to standard insurance premium calculation standards by the Ministry of Health and Welfare, announced Sunday.
- Insurance providers are eager to resolve the ongoing issues related to redundant refunds.
- The Ministry of Health and Welfare is pursuing a partial amendment to the guidelines for calculating insurance premiums.The proposed changes aim to adjust standard insurance premiums for self-payments,...
Table of Contents
- Health Ministry Reviewing Insurance Premium Standards; Industry Eyes Loss Coverage
- Industry Seeks Resolution to redundant Refund Issues
- proposed Amendments to Premium Calculation Criteria
- Call for Post-Payment Settlement Discussions
- Understanding the Copayment Limit System
- Income Clarity: A Key Challenge
- Insurers Deducting Excess Amounts
- Potential for Cost Reduction
- Industry Proposes Centralized Settlement System
- Reviving the Post-Payment Task Force
- Industry Official comments
- Health ministry Reviewing Insurance Premium Standards: Your Top Questions Answered
- What’s happening with insurance premiums in South Korea?
- Why is the ministry reviewing insurance premium standards?
- What are “loss-of-loss” medical insurance premiums?
- why are redundant refunds an issue for insurance providers?
- What changes are proposed for premium calculations?
- What’s the copayment limit system?
- What were the copayment limits in 2025?
- Why is income clarity a challenge for insurers?
- How are insurers currently handling the refund issues?
- What cost reductions are possible through streamlining processes?
- What solution is the industry proposing?
- What is the ‘Post-payment TF’?
- What’s the impact of the Supreme Court’s stance?
South Korea’s insurance sector is closely monitoring revisions to standard insurance premium calculation standards by the Ministry of Health and Welfare, announced Sunday. The industry hopes this review will reignite discussions surrounding loss-of-loss medical insurance premiums, talks of which have been stalled for over a year, and address the issue of overlapping refunds.
Industry Seeks Resolution to redundant Refund Issues
Insurance providers are eager to resolve the ongoing issues related to redundant refunds. They argue that the current system leads to wasted time and resources and negatively impacts the public perception of the insurance industry.
The Ministry of Health and Welfare is pursuing a partial amendment to the guidelines for calculating insurance premiums.The proposed changes aim to adjust standard insurance premiums for self-payments, aligning them with premiums paid by national health insurance subscribers in both workplace and local schemes. These adjustments will also reflect changes in the income levels of health insurance subscribers.
Call for Post-Payment Settlement Discussions
As the Ministry of Health and Welfare considers adjusting premium amounts, industry stakeholders emphasize the need to discuss post-payment settlements following refunds.
Understanding the Copayment Limit System
The copayment limit system is designed to reimburse health insurance subscribers for medical expenses exceeding a predetermined annual threshold. In 2025, these limits varied based on income quartile, ranging from 890,000 won for the lowest quartile to 826 million won for the highest.
Income Clarity: A Key Challenge
A primary obstacle in managing loss premiums and self-payment refunds is the difficulty insurers face in accurately assessing subscribers’ income levels. This lack of transparency makes it challenging for insurers to verify claims, even when a subscriber has already received a refund for copayments.
Insurers Deducting Excess Amounts
Currently, many insurers address this issue by deducting excess amounts, leading to complaints regarding refund timing and discrepancies with the Korea Health Insurance Corporation (KHIC).
Potential for Cost Reduction
Streamlining the process could also reduce unneeded administrative costs. Currently, insurers require customers to submit documentation to verify company ownership.
Industry Proposes Centralized Settlement System
The insurance industry suggests that if insurers were to pay the excess amount, the KHIC could initiate discussions on establishing a centralized system for benefit settlements across all insurance companies.
Reviving the Post-Payment Task Force
A ‘Post-payment TF’ consisting of representatives from the Ministry of Health and Welfare, the Financial Supervisory Service, the Health and Health Insurance Association, and the Credit Details Service, convened only once since its inception in February of last year. Industry representatives are calling for the task force to be revived or a new one created to continue these crucial discussions.
Industry Official comments
An industry official, speaking on the condition of anonymity, stated that the Supreme Court’s stance on depreciation not being subject to loss-of-loss benefits has increased expectations for the swift implementation of a post-payment system.
The South Korean Ministry of Health and Welfare is currently reviewing standard insurance premium calculation standards.This review has the South Korean insurance sector closely watching for potential changes,especially concerning loss-of-loss medical insurance premiums and overlapping refunds.
The primary goal of the review is to potentially revise the current guidelines for calculating insurance premiums.These changes are anticipated to adjust standard insurance premiums for self-payments and align them with premiums paid by national health insurance subscribers. These adjustments are planned to also reflect changes in income levels of health insurance subscribers.
Loss-of-loss medical insurance premiums are a specific type of insurance coverage. Sadly, the provided article offers limited information on these premiums beyond their being a subject of industry discussion. It is indeed mentioned that discussions about them have been stalled for over a year.
why are redundant refunds an issue for insurance providers?
insurance providers are seeking a resolution to issues related to redundant refunds for several reasons:
- Wasted Resources: The current system is inefficient, leading to wasted time and resources.
- Public Perception: Handling redundant refunds negatively impacts the public’s view of the insurance industry.
The Ministry of Health and Welfare proposes partial amendments to the premium calculation guidelines to:
- Adjust standard insurance premiums for self-payments.
- Align these with premiums paid by national health insurance subscribers in both workplace and local schemes.
- Reflect changes in the income levels of health insurance subscribers.
What’s the copayment limit system?
The copayment limit system is designed to reimburse health insurance subscribers for medical expenses exceeding a predetermined annual threshold.
What were the copayment limits in 2025?
In 2025, the copayment limits varied based on income quartile.
Here’s a summary:
| Income quartile | Copayment Limit (Won) |
|---|---|
| Lowest | 890,000 |
| Highest | 826,000,000 |
Why is income clarity a challenge for insurers?
Accurately assessing subscribers’ income levels is a significant obstacle for insurers. This lack of clarity makes it challenging to verify claims, even when a subscriber has already received a refund for copayments. This challenge directly impacts the management of loss premiums and self-payment refunds.
How are insurers currently handling the refund issues?
Many insurers currently address refund issues by deducting excess amounts.This practice leads to complaints regarding refund timing and discrepancies with the Korea Health Insurance Corporation (KHIC).
What cost reductions are possible through streamlining processes?
Streamlining processes could reduce unneeded administrative costs. For example, insurers currently require customers to submit documentation to verify company ownership; reducing the need for documentation verification can streamline processes, reduce costs, and improve customer satisfaction.
What solution is the industry proposing?
The insurance industry suggests that if insurers pay the excess amount, the KHIC could initiate discussions on establishing a centralized system for benefit settlements across all insurance companies.
What is the ‘Post-payment TF’?
The ‘Post-payment TF’ (Task Force) consists of representatives from:
- The Ministry of Health and Welfare
- the Financial Supervisory Service
- The Health and Health Insurance Association
- The Credit Details Service
The TF convened only once since its inception in February of last year,and industry representatives seek its revival or the creation of a new task force to continue crucial discussions.
What’s the impact of the Supreme Court’s stance?
An industry official noted that the Supreme Court’s stance on depreciation not being subject to loss-of-loss benefits has increased expectations for the swift implementation of a post-payment system. This decision is believed to have brought increased expectations for the swift implementation of a post-payment system.