In most cases, a claim for Korean private indemnity health insurance is completed in two steps: receiving documents from the hospital and uploading a photo to the insurance company’s app or Silson24. If the amount is not large, a receipt alone will be accepted, but which documents are required will vary depending on the amount claimed and the nature of the treatment.
Below, we outline how to collect documents at once, the differences between claim routes, and the order in which you can check how much your insurance will refund. Since the scope of coverage and deductible rate vary depending on the time of subscription and product, you must check your policy and insurance company for the specific amount.
Summary
- The basic documents are medical payment receipt + itemized medical bill. If the amount increases, an additional medical certificate or prescription will be required.
- There are three claim routes: insurance company app, Real Loss 24 (computerized claim), and call center/fax.
- Copayment rate and outpatient deductible amount vary depending on the policy generation (1st to 4th generation).
- The statute of limitations for claims is 3 years from the date of occurrence of the reason for insurance payment, so it is also worth checking overdue receipts.
1. Check before claiming – Which policy generation do I have?
Even if it is the same “Korean private indemnity health insurance,” the structure is different depending on when you subscribe. If you do not know the policy generation, you can’t estimate how much it will cost, and it’s difficult to decide whether to claim it or not.
| Generation | Approximate sales time | Structural features |
|---|---|---|
| 1St generation | Before September 2009 | There are many products with no or very low deductible. There are also contracts designed with long renewal cycles. |
| 2Nd generation | October 2009 ~ March 2017 | Standardized indemnity coverage. Integrated coverage of covered and non-covered care, introduction of copayment rate |
| 3Rd generation | April 2017 – June 2021 | Basic type + 3 non-covered special contracts (manual therapy, injections, MRI) separated |
| 4Th generation | July 2021 ~ | Insurance-covered care/non-covered care separation, insurance premium discount/surcharge for the next year depending on non-covered care usage |
You can confirm your policy generation by checking the subscription date on the insurance policy, contract details in the insurance company app, or inquiring at the call center. If you have multiple contracts, you can search for the contracts in your name at once through Find My Insurance (operated by the Korea Life Insurance Association and General Insurance Association of Korea).
The exact copayment rate and outpatient deductible vary depending on the generation, product, special contract, and renewal history. It is definitely better to look directly at the benefits and exclusions section in the terms and conditions rather than just believing charts circulating online.
2. Prepare documents — receive them at once from the hospital
You can save yourself the trouble of visiting again by requesting the necessary documents from the hospital billing desk when completing treatment and making payment. In the clinic, there are quite a few people who come back a few days later just to receive documents, but most of the time, this can usually be avoided by requesting the documents at the time of payment.
2-1. Basic documents by amount
| Billing Type | Documents normally required |
|---|---|
| Small outpatient care (usually tens of thousands of won) | Medical payment receipt |
| General outpatient visit | Medical payment receipt + itemized medical bill |
| Prescription drug costs | Pharmacy receipt + copy of prescription |
| Large billing/hospitalization | The above documents + medical certificate (or admission/discharge confirmation), surgical records, etc. |
The standard amount varies from insurance company to insurance company. Some places require 100,000 won, while others set a higher amount as the standard for requesting a medical certificate. If you read the app instructions first before being rejected as “insufficient documents” on the application screen, you will save on round trips.
2-2. Why the itemized medical bill matters
Only the total amount is recorded on the receipt, but on the detailed calculation statement, the consultation fee, test fee, and treatment are divided into insurance-covered care and non-covered care. Since the 3rd generation and later products have different processing methods for benefit and non-covered care, without this document, the insurance company cannot divide the items and the review stops.
2-3. Acceptable document formats
- Copies and photographs are also accepted in most cases. However, the letters must be readable without the four corners being cut off.
- In some cases, the original copy of the medical certificate may be required, so it may be necessary to submit it by mail.
- When filing a claim on behalf of a family member, additional documents related to delegation or confirmation of family relationship are required.
3. Three claim-submission routes
3-1. Insurance company app/homepage
This is the most common method. After logging in, enter the insured person and accident (disease) information in the insurance claim menu, take a photo of the documents, and upload them. Review usually takes a few days, and processing times will increase as additional documents are requested.
3-2. Silson24 — Direct transmission from hospital to insurance company
With the computerization of Korean private indemnity health insurance claims implemented in October 2024, participating medical institutions will transmit medical information to insurance companies without patients having to submit documents. Users request transmission after verifying their identity through the Silson24 app or web.
However, not all hospitals and pharmacies participate. The target has been expanded to clinics and pharmacies starting in October 2025, but actual system integration varies from institution to institution, so it is quicker to first check whether the institution appears in Silson24. If it is not checked, you will have to obtain the documents in the traditional way.
3-3. Call center, fax, mail
If you are an older adult, have a lot of documents, or are repeatedly rejected by the app, it is better to consult a call center. Trial and error is reduced because the reviewer in charge specifies the required documents.
4. Points to consider when deciding whether to file a claim
Small claims are not always beneficial. For fourth-generation policies, the insurance premium is increased the following year depending on the amount of non-covered insurance money received, so there may be cases where you receive a few thousand won back and the renewal insurance premium increases.
There are three pieces of information needed to make a decision. The outpatient deductible in my contract, whether it is a non-covered care item, and if I am a 4th generation, the cumulative amount reimbursed for non-covered care. The first two are checked in the terms and conditions and detailed calculation statement, and the last is checked in the contract details of the insurance company’s call center or app. Each insurance company has different guidance methods, so it is necessary to ask them directly at least once.
5. Common problems
- Statute of limitations: The right to claim insurance money is 3 years. Receipts stored in a drawer can also be accepted as long as they are within 3 years.
- Multiple contracts with different companies: Private indemnity insurance does not provide duplicate reimbursement; claims are apportioned across policies. Even if you are enrolled in two insurance companies, you will not receive double the amount and must file a separate claim with each insurance company.
- Medical treatment for health checkup purposes: Checkups that are not for the purpose of treating a disease are often excluded from compensation.
- Car accident/industrial accident: A different compensation system is applied first and the processing path varies.
If you are curious about your medical treatment history, you can search by period in the National Health Insurance Corporation’s ‘Information on medical treatment received’. However, since non-covered care items do not appear here, documents issued by the hospital must be used as data for insurance claims.
Frequently Asked Questions
Q. I lost my receipt. Can I get it back? A. Re-issuance is possible at the administrative department of the medical institution where you received treatment. Each institution has different storage periods and issuance fee policies, so it is better to check by phone before visiting.
Q. If I use Silson24, can I skip the documentation altogether? A. This only applies if the medical institution in question is linked to the system and the item you wish to claim is included in the transmission target. If an institution is not linked or documents that require separate issuance, such as a medical certificate, are requested, they must be prepared in the same way as before.
Q. I visited multiple hospitals on the same day. Do I get billed at once? A. Since receipts and statements are issued separately for each institution, it is common to submit them on a case-by-case basis. Outpatient deductions are usually applied on a per-visit basis, but the application method varies depending on the contract, so please check the outpatient definition clause in the terms and conditions.
This article is general health information and is not a substitute for individual medical care. If symptoms persist or worsen, please seek treatment at a medical institution.