Implants after self-extraction are also excluded.
Mr A was advised that he needed crown treatment, which involves covering the tooth with metal, etc., due to molar cavities. He joined dental insurance late, received treatment, and filed a claim, but the insurance payment was denied on the grounds that he was diagnosed before the start date of coverage. The Financial Supervisory Service explained, “Under the terms and conditions of dental insurance, after registering for insurance, you must be diagnosed and receive prosthetic or conservative treatment for cavities and periodontal disease in order to receive insurance benefits.”
On the 3rd, the Financial Supervisory Service provided guidance on ‘Warnings relating to third party insurance such as health and accident insurance,’ including this information. You cannot receive insurance benefits if you extract a tooth on your own without a dentist’s diagnosis and then have an implant treatment by the dentist or replace previously treated bridges (a method of placing dentures using the two healthy teeth as supports), implants, crowns, etc. In addition, for bridges and implants, insurance premiums are calculated based on the number of permanent teeth removed.
In terms of nursing care insurance, the Financial Supervisory Service advised that it is necessary to distinguish whether the insurance you have signed up for is a ‘carer support special contract per day in hospital’ or a ‘carer use special contract per day’. In the case of a special contract for carer support per hospital day, carer support or a hospital stay every day is guaranteed, so if you use it voluntarily without applying to the insurance company for a carer , you may not be compensated for the cost. Even if you receive treatment for an injury and illness during your stay in hospital, if the hospital is only for the purpose of treating your injury, you will not get the daily hospital sickness allowance.
Reporter Kim Soo-yeon syeon@donga.com
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