boxlogodev
KO/EN
ECONOMY BOX / INSURANCE

Documents and Deadlines for Indemnity Health Insurance Claims — Just the Lists, Limitation Periods and Routes

BOXLOGODEVTranslated from Korean 한국어 원문 보기

This English version is a translation of the original Korean post. Text, screenshots and product details reflect the date it was written.

A kraft paper folder labeled CLAIM, PATIENT DOCUMENTS, MEDICAL EXPENSES with blank name, date of service, claim ID and submitted lines, beside a slip stamped RECEIVED on a dark desk.

There are three boxes to check: documents, limitation period and route. Product comparisons and coverage limits are not opened.

This post covers Korean indemnity health insurance (silson) rules, and the linked official sources are in Korean.

1. What is indemnity health insurance?

Article 102-6 of the Insurance Business Act calls indemnity health insurance "a third-sector insurance product that pays only the medical expenses actually borne." (S1)

Financial Supervisory Service: "Indemnity health insurance is a product that compensates medical expenses actually borne due to illness or injury." (S2)

Korea Life Insurance Association: "Indemnity health insurance is a product in which the insurance company compensates the medical expenses actually borne by the policyholder for inpatient or outpatient treatment due to illness or injury." (S16)

The Health Insurance Review and Assessment Service reviews National Health Insurance benefit claims submitted by medical institutions. The transmission agent for indemnity insurance is the Korea Insurance Development Institute (Silson24). The Health Insurance Review and Assessment Service's benefit review is not the indemnity insurance claim channel. (S17, S9)

2. Documents needed for a claim

The General Insurance Association of Korea's consumer portal publishes the standard list of claim documents for indemnity health insurance, in effect since January 1, 2014. "Amount brackets are based on the amount paid per accident." (S5)

Common: claim form (including consent to processing of personal (credit) information and account number), copy of the claimant's ID. (S5)

Outpatient

BracketDocuments listed in the standardSource
30,000 won or lessClaim form with the diagnosis written on it, medical bill receipt. However, obstetrics and gynecology, proctology, urology and dermatology treatment are excluded[S5]
Over 30,000 won up to 100,000 wonClaim form, medical bill receipt, prescription showing the disease classification code. Same departments excluded[S5]
Over 100,000 wonClaim form, hospital receipt, prescription (disease classification code). Additional evidence if needed: medical certificate, outpatient visit confirmation, treatment confirmation, doctor's opinion, medical chart, etc.[S5]

Inpatient

For inpatient medical expenses, submit a medical certificate, an itemized statement of medical charges and a medical bill receipt. When the amount is 500,000 won or less, an admission and discharge confirmation or a treatment confirmation that includes the diagnosis and the period of hospitalization may be used instead of the medical certificate. (S5)

Financial Supervisory Service example for indemnity insurance: confirmation documents such as a claim form, a medical bill statement, an inpatient treatment confirmation and a doctor's prescription, and an ID. (S2)

Examples of proof of accident in Article 6 of the standard terms and conditions for indemnity health insurance: medical bill statement, itemized statement of medical charges, inpatient treatment confirmation, doctor's prescription (for prescription dispensing costs), etc. (S18)

Where each document is issued

DocumentWhere you get itDeadline box
Claim form (including consent and account number)Insurance company formLimitation period for the claim right: 3 years under the Commercial Act. The Financial Supervisory Service wording counts from when the insured event occurred ([S6][S2])
Copy of the claimant's IDThe claimantSame as above
Medical bill statement and receiptMedical institutions are obliged to issue them (Rules on Standards for National Health Insurance Care Benefits, Article 7(1))The limitation period is not counted from the document's issue date. The medical institution's 5-year retention of duplicates is the institution's retention duty, not the claim limitation period ([S15])
Pharmacy bill statement and receiptPharmacies, etc. ([S15] Article 7(1)3)Same as above. Electronic transmission applies to linked pharmacies and after the effective date
Itemized statement of medical chargesMedical institution. Provided on request ([S15] Article 7(3))Included in the inpatient standard
Prescription (disease classification code)Issued by the doctor who examined you in person, etc. (Medical Service Act Article 17-2)Outpatient bracket over 30,000 won. One of the three documents transmitted electronically
Medical certificateIssued by the doctor who examined you in person, etc. (Medical Service Act Article 17)Inpatient standard. For 500,000 won or less, may be replaced by an admission and discharge confirmation, etc. Not sent automatically by Silson24; attach separately
Admission and discharge confirmation / treatment confirmationMedical institutionReplacement for inpatient claims of 500,000 won or less. Attach separately in Silson24
Outpatient visit confirmation, doctor's opinion, medical chartMedical institutionAdditional outpatient evidence (if needed)

"Additional review documents may be requested depending on the details and nature of the accident and the product (coverage)." (S5)

Financial Supervisory Service: the required documents vary with the type and details of the accident, so get guidance from the insurer's claims handler. (S3)

Check the required documents through each insurance company's call center and your agent. (S4)

3. Claim deadline and extinctive prescription

Commercial Act Article 662: "The right to claim insurance money shall be extinguished by prescription if not exercised for 3 years, the right to claim the return of premiums or reserves if not exercised for 3 years, and the right to claim premiums if not exercised for 2 years." (S6)

The main text of Commercial Act Article 662 does not specify the starting point. The Financial Supervisory Service wording says that "if you do not claim within 3 years from when the insured event occurred, the right to claim insurance money is extinguished." Civil Act Article 166(1) says that "extinctive prescription runs from the time the right can be exercised." (S2, S7, S6)

Notice of the accident is a different box from the limitation period. "When you learn that an insured event has occurred, you must send notice of it to the insurer without delay (Commercial Act Article 657(1))." (S4)

The payment deadline is also a different box from the limitation period. "In principle, payment within 3 business days from the date the claim is received (however, some product groups differ). But where investigation or verification is needed, payment within 10 business days from the date the claim is received." (S4)

4. Claim routes

Existing routes: call center, fax, internet, customer center counter. (S4)

Insurance Business Act Article 102-6: policyholders and others may ask a medical institution to send documents designated by the Financial Services Commission, such as the medical bill statement and receipt and the itemized statement of medical charges, to the insurance company in electronic form. Without a justifiable reason, the institution must comply with the request. (S1)

The transmission agent is the Korea Insurance Development Institute. The channel is the Silson24 app or website (https://www.silson24.or.kr). (S11, S9)

An electronic indemnity insurance claim is not requested from the hospital; the policyholder carries it out directly in the Silson24 app or website. (S14)

PhaseDateCovered institutionsSource
Phase 12024-10-25Hospital-level institutions (30 or more beds), public health centers[S8][S10]
Phase 22025-10-25Clinics and pharmacies in addition to hospital-level institutions and public health centers[S11]

Medical expense records arising on or after October 25, 2024 can be transmitted. (S14)

Three kinds of documents are transmitted electronically: (1) bill statement and receipt (2) itemized statement of medical charges (3) prescription. (S11)

The medical certificate and the admission and discharge confirmation needed for inpatient claims and the like are not transmitted automatically. The policyholder photographs them and attaches them separately in Silson24. (S14)

This post does not say that every hospital is linked. Financial Services Commission press release of April 15, 2026: as of April 1, 2026, 29,849 institutions had completed linkage out of 104,925 in total, a linkage completion rate of 28.4%. If the medical institution you used is not linked, you can submit the usual paper documents or request linkage with "Request participation". (S12, S11)

Exceptions to transmission (justifiable reasons): draft Article 4-45 in the regulation change notice of July 10, 2024 lists a business suspension order against the medical institution, not using an electronic medical record system, temporary or permanent closure, and so on. The reasons for the Enforcement Decree amendment cite cases where transmission is impossible due to failure, repair or inspection of the indemnity insurance electronic system. (S13, S20)

Sources

ECONOMY BOXBack to ECONOMY BOX

Keep reading

Insurance

Health Insurance Dependents: Just the Requirements for Gaining and Losing Status

19 min read
Insurance

Job-Seeking Benefit Eligibility and Benefit Period: Insured Unit Period and Prescribed Benefit Days

20 min read
Insurance

The Four Social Insurances When Leaving or Changing Jobs — Just What to Do at Each Agency

16 min read