What are the 7 things you need to know before filing an insurance claim?
There are things you need to know before filing a claim for actual cost insurance. What are the corresponding things?
This insurance, also called actual cost insurance, actual cost medical insurance, or actual medical expense insurance, is an insurance product that compensates for 90% of medical expenses incurred at hospitals or pharmacies.
If you ask which of these types of insurance is essential, actual cost insurance would be first.
This is because actual cost insurance is so useful.
However, it is known that there are quite a lot of people who actually sign up for actual cost insurance and do not file a claim if it is a small amount of less than 10,000 won because it is cumbersome to file a claim. According to one data, when medical expenses are less than 10,000 won, the number of cases of unclaimed insurance amounts to 51.4%. Therefore, this time, let’s take the time to learn about how to simply claim actual cost insurance and what you need to know before filing a claim.
What about actual cost insurance?
Actual cost insurance is an insurance called actual cost medical insurance. When a subscriber of actual cost insurance receives treatment at a hospital due to an illness or injury, actual cost insurance is a product that pays after deducting the deductible from the amount of the deductible and non-benefit items. .
For reference, the subscriber can decide on the deductible when planning insurance.
What kind of actual cost insurance claim documents do you need?
Preparing insurance claim documents
All you have to do is fill out your personal information, bank account number, and circumstances surrounding the accident.
Documents can be downloaded from the insurance company’s website and can be replaced with invoice documents through the application.
Preparation of actual cost insurance documents
ID card, medical fee receipt, detailed statement of medical fees (free), pharmaceutical fee receipt, prescription, hospitalization confirmation (paid, approximately 1,000 to 2,000 won), medical certificate (paid, approximately 10,000 to 20,000 won), and the medical fee receipt is not a card receipt, but a standard receipt listing treatment and examination items. must be issued.
A standard receipt refers to a receipt that meets the standards for the detailed calculation details of medical expenses among the rules on the standards for National Health Insurance nursing care benefits announced by the Ministry of Health and Welfare in March 2018.
The receipt includes the actual cost/number of uses, period, and total amount. Please note that it cannot be replaced with a medical expense payment confirmation for income deduction purposes. The detailed statement of medical expenses is a document that contains more detailed information about what I was prescribed and treated for.
For example, it is easy to think of it as a document that contains information such as what time the injection was given and what treatment was received.
For people who are hospitalized, this is a document often issued when filing an insurance claim.
Please note that detailed statements of medical expenses need to be submitted only when non-covered items occur. Receipts for medication expenses are usually written on the back of medication envelopes.
Details of out-of-pocket expenses and non-benefit expenses are recorded, and this also cannot be replaced with a card receipt. The disease code is recorded on the prescription and can be used in place of a medical certificate.
Usually, small hospitals only give prescriptions for submission to the pharmacy, but the original obligation is to provide prescriptions for patient storage. The hospitalization confirmation is a document that records the reason for hospitalization. A medical certificate is a document that records the results of a patient’s diagnosis by the attending physician, and is used by insurance companies to determine insurance coverage. If you are hospitalized, the insurance company must ask you. If the insurance company requests a medical certificate and a confirmation of hospitalization and discharge containing the name of the diagnosis, you must prepare in advance. For reference, you can obtain a medical certificate and confirmation of admission and discharge from the hospital by paying money.
The price is approximately 10,000 to 20,000 won for a medical certificate and approximately 1,000 to 2,000 won for a hospitalization confirmation.
Medical certificates are expensive, so preparing a cheap hospitalization certificate is a way to save some money.
For reference, the issued document must contain the disease classification code. For reference, the issued document must contain the disease classification code.
If it feels a little complicated, please refer to the simple summary below.
Summary of actual cost insurance claim documents
Basic required documents when claiming medical expense insurance – ID card, medical fee receipt, detailed medical fee statement (required in case of non-covered items) Required documents for outpatient treatment – medical fee receipt, pharmaceutical fee receipt, prescription Documents required for hospitalization or surgery due to illness – medical certificate, medical certificate, etc. Documents required for hospitalization or surgery due to an accident such as discharge confirmation, hospital bill receipt, etc. – Medical certificate, admission/discharge confirmation, hospital bill receipt + accident fact confirmation, etc.
Please click the link below to accurately check Samsung Fire & Marine Insurance’s actual cost insurance claim documents on the website.
Go to Samsung Fire & Marine Insurance’s actual cost insurance claim form website
What billing documents are required if the hospital bill is less than 100,000 won?
Medical bill receipts, pharmaceutical bill receipts, prescriptions, insurance claims, etc. When claiming treatment costs from plastic surgery or dermatology, a medical certificate may be requested.
The reason for this is to determine whether it is for therapeutic or cosmetic purposes. In this case, you may submit a prescription instead of a medical certificate.
Claiming documents required if hospital expenses exceed 100,000 won
Medical bill receipt, pharmaceutical bill receipt, prescription, insurance claim, detailed medical bill statement or medical certificate, if the hospital bill exceeds 100,000 won, medical bill receipt, pharmaceutical bill receipt, prescription, insurance claim, medical certificate, detailed medical bill statement, outpatient confirmation, medical confirmation, opinion, and medical chart. Additional requests may be made, so please take note of these points. In addition, if the claim is for a non-covered item that is not covered by medical insurance, such as manual therapy, a detailed statement of medical expenses is required, and if the claim amount exceeds 500,000 won, it is advisable to prepare a medical certificate.
What billing documents are required when hospitalized?
Medical fee receipt, detailed medical fee statement, hospitalization confirmation or medical certificate
Invoice documents required when the insured and the beneficiary are different
Beneficiary’s ID card, copy of beneficiary’s bankbook, documents proving relationship (copy, family relationship certificate, marriage certificate, etc.) The insured person refers to the person who receives insurance benefits, and the beneficiary refers to the person who receives the insurance money.
Usually, in cases where the insured and the beneficiary are different, the insured is often a minor, so keep this in mind.
Actual cost insurance claims are different for each insurance company.
Although actual cost insurance claims are mostly similar, there may be slight differences between insurance companies.
So, in order to claim actual cost insurance most accurately, the best way is to call the insurance company you want to use and ask.
We recommend that you search for actual cost insurance claim documents through the website or mobile app. If you find it inconvenient, we have organized the actual cost insurance claim documents for each insurance company below, so please read the article until the end.
How long is the actual cost insurance claim period?
Statute of limitations for insurance claims – 3 years In case of actual cost insurance, you can receive insurance money only if you file a claim within 3 years after the accident occurred.
Originally, the actual cost insurance claim period (application period) was 2 years, but from March 12, 2015, an additional year was added, so you can receive insurance money if you file a claim within 3 years.
When is the actual cost insurance claim period calculated?
It was explained above that actual cost insurance must be claimed within 3 years after the accident.
So when is the first day the standard when counting periods?
The first day is the date of diagnosis in case of illness.
If you go to the hospital today and the doctor confirms that you have a certain disease, it will be three years from that day.
Additionally, in the case of a traffic accident, the day the accident occurred is considered the first day. For residual disabilities that can be determined after an accident, the first day is considered to be the day a doctor confirms the disability. The statute of limitations for claims for damages due to illegal acts by medical professionals or other causes is three years from the date the victim or the victim’s representative became aware of the damage.
What does the actual cost insurance claim period and statute of limitations mean for insurance claims?
Please be aware of both the actual cost insurance claim period (application period) and the meaning of the statute of limitations for claiming insurance money.
In fact, these have the same meaning, and the statute of limitations for insurance claims also refers to the period during which the person with the right to receive compensation can exercise the right to claim insurance money. If you do not file an insurance claim by a certain date, it is assumed that you will not file a claim and you no longer have the right to file a claim. It is recommended that you get to know the words as they have similar meanings.
When can I make a claim for actual cost insurance?
When can I make a claim for actual cost insurance?
As explained above, you can receive insurance money if you file a claim within 3 years of completing treatment.
What is the actual cost insurance payment period?
In general, the payment period under the Insurance Business Act is that insurance money is paid within 3 business days.
Here, three business days means days excluding days when the insurance company is not working, such as Saturdays, Sundays, and national holidays.
Actual cost insurance claim period by company – Hyundai Marine & Fire Insurance, Meritz Fire & Marine Insurance, Dongbu Fire & Marine Insurance, Post Office, etc.
Hyundai Marine & Fire Insurance, Meritz Fire & Marine Insurance, Dongbu Fire & Marine Insurance, and the Post Office can all receive actual cost insurance if they file a claim within 3 years from the date of the accident.
Is it possible to file an insurance claim after 3 years?
The actual cost insurance claim period is 3 years. However, we recommend that you file a claim even if three years have passed.
Sometimes there are places that offer compensation.
Can I file an actual cost insurance claim at once?
For actual cost insurance, you can file multiple claims at once.
You can claim them one by one, but in this respect, it is the same as claiming them all at once, so if you have the opportunity, it is recommended to claim them all at once. You can receive insurance money no matter how you file your claim, and even if you make multiple claims, there is no problem because each case is reviewed and compensation is paid.
Can I file a claim immediately after signing up for actual cost insurance?
You can file a claim immediately after signing up for actual cost insurance.
However, if you sign up and file a claim right away, the insurance company may conduct an on-site due diligence.
Please keep this in mind as you can check because it does not mean there is a violation of the notification obligation just because you have conducted a field inspection.
Will there be any disadvantages if I claim a lot of actual expenses?
Starting with the 4th generation actual cost insurance, premiums were increased by up to 300% depending on the non-benefit claim amount.
However, if it is not a 4th generation actual cost insurance, there is no surcharge even if you file an insurance claim. The reason for this is that the 4th generation actual cost insurance is an insurance whose premiums rise when an individual claims a lot.
However, in the case of actual cost insurance before the 4th generation, if the people who subscribed to the actual cost insurance make a lot of claims, the insurance premiums all rise. am.
All subscribers must make fewer claims, but the insurance premiums will rise less.
Is there a limit to the number of claims for actual cost insurance?
So how many times can a claim be made per year? Will insurance premiums go up depending on the number of claims?
Actual cost insurance has no limit on the number of claims.
However, if you make a lot of claims, as explained above, the insurance premium may rise for those who subscribe to 4th generation actual cost insurance.
For those who subscribed to the previous generation’s actual cost insurance, please note again that even if an individual makes a small claim, if other subscribers file a large number of insurance claims, the rate rises together.
What is the minimum amount that can be applied for for actual cost insurance?
With actual cost insurance, you can make a claim even if it is a small amount, as long as the claim amount is more than the deductible.
The deductible amount varies depending on the medical institution.
The minimum amount that can be claimed is as follows: Clinic – 10,000 won or more Hospital – 10,000 won or more 5,000 won or more General hospital – 20,000 won or more Pharmacy – 8,000 won or more
Is it possible to file a small claim for actual cost insurance?
With actual cost insurance, you can file a claim for small amounts.
However, as explained above, the minimum amount must be met.
Claims can be made for amounts exceeding 10,000 won at the clinic level, 15,000 won or more at the hospital level, and 20,000 won or more at the general hospital level. Additionally, you can also claim insurance if the amount exceeds 8,000 won at a pharmacy.
In other words, if you meet the minimum amount, even if it is a small amount, you can file an insurance claim.
How long will it take for actual cost insurance to be paid?
You can usually receive insurance money within 3 days. Life insurance companies must pay within 10 days, non-life insurance companies within 7 days. In general, insurance companies must pay claims within 3 business days from the date of receipt of claim documents.
However, if an investigation is necessary for insurance payment, payment will be made within 10 business days for life insurance companies and within 7 days for non-life insurance companies. If there are no special circumstances, you can receive insurance money within 3 days. In fact, you can expect it to arrive in 1-2 days on average.
How do I file a claim for actual cost insurance?
(How to claim actual cost insurance)
There are two ways to file a claim for actual cost insurance: download the required documents through the website and submit them by fax or through an app.
The method introduced this time can be easily performed using the toss app.
How to claim actual cost insurance using the toss app (actual loss insurance)
Access the toss app Connect your account Select the hospital bill refund button Click the claim my hospital bill button Select the insurance company you signed up for Verify your identity and select an account to receive insurance money Enter diagnosis date and diagnosis details Signature Attach photo of claim form
The easiest apps to claim actual cost insurance include the following apps.
Immediate claim for actual loss insurance
The app above is a very simple actual cost insurance claim application that is used by most people. If you want to easily claim actual cost insurance through the app, please refer to the app above.
How to claim actual cost insurance (process and method)
The actual cost insurance claim process is simpler than the actual cost insurance claim process.
Once you start applying, you will be screened for insurance payment and on-site verification.
Next, after the on-site confirmation by the damage adjustment company, the insurance claim is reviewed and whether payment is made. After that, payment or sub-payment is provided. To help you understand better, let’s explain DB Life Insurance’s insurance claim process and method as an example.
How to claim DB Life Insurance for actual expenses
How to claim DB Life Insurance for actual expenses
DB Life Insurance’s actual cost insurance claims can be filed through online application, mobile application, fax application, mail application, or in-person application. The process is as follows.
What is the DB Life insurance payment procedure?
What is the scope of actual cost insurance claims?
The scope of actual cost insurance claims varies slightly depending on which hospital it is.
If you are at the clinic level, you can file a claim for actual cost insurance starting from 10,000 won.
If you received treatment at a hospital rather than a clinic, you can claim actual cost insurance starting from 15,000 won. In the case of high-level general hospitals, you can claim actual cost insurance starting from 20,000 won, and you can also claim actual cost insurance at pharmacies that other people are not familiar with.
In the case of pharmacies, as explained above, if you paid more than 8,000 won, you can claim actual cost insurance.
Documents required when claiming actual cost insurance premiums (actual loss insurance claim documents)
What are the Hyundai Marine & Fire Insurance actual cost insurance claim documents?
Joint documents
When prescribing a medical fee receipt from an outpatient clinic, it is not possible to submit a pharmaceutical fee receipt card slip or a medical fee payment confirmation for income deduction verification.
Documents required if hospitalized
Medical certificate, detailed (calculation) statement of medical expenses, confirmation of admission and discharge
Required documents in case of mobilization
Prescription (If the disease classification code is not entered on the prescription, additional supporting documents (diagnosis, opinion, etc.) must be submitted as necessary) Detailed (calculation) statement of medical expenses (required to be submitted when non-covered medical expenses occur) If you want to see the Hyundai Marine & Fire Insurance billing documents in detail, click the link below. I hope you do.
View Hyundai Marine & Fire Insurance invoice details
DB Life Insurance Actual Expense Insurance Claim Documents
If you would like to see DB Life Insurance’s actual cost insurance claim documents in detail, please click the link below.
DB Life Insurance Actual Expense Insurance Claim Form Details
What are the documents for Hanwha Life Insurance’s actual cost insurance claim?
Joint documents
Insurance claim (detailed consent form for insurance claim, including account number) Real name confirmation – Claimant (beneficiary), identification card (select one from resident registration card, driver’s license, passport, or alien registration card) Card slip and income deduction citation medical fee payment confirmation cannot be submitted. do.
What documents are required if hospitalized?
Medical certificate or confirmation of admission and discharge, receipt of medical expenses, detailed statement of medical expenses
Documents required in case of outpatient visit
Choose 1 from medical certificate, outpatient visit confirmation, medical treatment confirmation, opinion, medical chart, prescription (by date of outpatient visit)
– Diagnosis name (disease cause classification code), date and period of outpatient visit, date of accident (onset), etc. must be recorded. If you would like to see the Hanwha Life Insurance Actual Expense Insurance claim documents in detail, please select one of the following: prescription with disease classification code (free), medical certificate, outpatient confirmation, medical treatment confirmation, opinion, medical chart, medical treatment fee receipt by date, and detailed medical expense statement. Please click the link below.
View Hanwha Life Insurance actual cost insurance claim documents in detail
What are the KB Insurance actual expense insurance claim documents?
– Detailed consent form for insurance claim (our form)
– Copy of claimant’s ID card [미성년자 생략]
(The back of the resident registration card is not collected.) Our form※ [필요시] Additional documents
– When family relationships need to be confirmed
(Products covered for spouses, children, etc., cases where the beneficiary is a minor, etc.)
: Family relationship documents (e.g. family relationship certificate, marriage relationship certificate, etc.) Community Center ※ In case of entrusting insurance money to another person
– Power of attorney (our company form, stamp or signature)
– Submit a certificate of seal impression (or confirmation of personal signature)
– Detailed consent form (our form) for insurance claim holders and others to file insurance claims. Community Center
Our form※ Precautions when issuing a medical certificate
Be sure to submit a medical certificate containing the Korean Standard Disease Classification of Causes of Death number. Hospitalization at a medical institution – medical certificate (disease classification code (diagnosis name), hospitalization and discharge period must be entered)
ㆍConfirmation of admission and discharge (disease classification code (diagnosis name)) or
Can be replaced with medical treatment confirmation (disease classification code (diagnosis name), admission and discharge period required)
– Medical expenses invoice (receipt)
– Detailed statement of medical expenses (can be omitted if there is no non-coverage history) Medical institution outpatient visit 30,000 won or less
– Medical bill (hospital/pharmacy receipt)
– Detailed medical expenses statement exceeds 30,000 won ~
Less than 100,000 won
– Medical bill (hospital/pharmacy receipt)
– [질병분류코드가 기재된] Prescription (free)
* [질병분류코드가 기재된] If you do not have a prescription
Right ※ Additional supporting documents may be requested.
– Detailed medical expenses statement
Exceeding 100,000 won
– Medical bill (hospital/pharmacy receipt)
– [질병분류코드가 기재된] Prescription (free)
– Detailed medical expenses statement
– If necessary, on the right ※Request for submission of additional documents
※ The detailed medical expense statement can be omitted if there is no non-coverage information.
※ Medical expenses invoices (hospital/pharmacy receipts) are standard receipts (legal forms under the Medical Service Act) that allow item classification, and do not apply to ‘medical expense payment confirmation’ or ‘card payment receipts’ for income deduction purposes.
※ You can receive a “patient storage” prescription free of charge from the hospital.
※ Please understand that submission of additional supporting documents may be required when review is deemed necessary, such as in cases where there are many medical specialties excluded from coverage (obstetrics and gynecology, proctologic surgery, urology, dermatology, etc.) or when the number of insurance claims is excessive within a short period of time. We provide medical institutions
If you would like to see the KB Insurance claim documents in detail, please click the link below.
View KB Insurance claim documents in detail
Samsung Fire & Marine Insurance actual cost insurance claim form
(Only standard receipts (legal form under the Medical Service Act) that can distinguish between items are accepted; ‘Confirmation of Medical Expense Payment’ for income deduction verification cannot be submitted) Prescription (indicate the disease classification code) Detailed statement of medical expenses (submit when non-coverage occurs) Medical institution
If you would like to see Samsung Fire & Marine Insurance’s actual cost insurance claim documents in detail, please click the link below.
View Samsung Fire & Marine Insurance actual expense insurance claim details
How to submit actual cost insurance claim documents?
Submission of actual cost insurance claims can be done through the insurance company’s mobile app, fax, online website, mail, or in person.
Concluding the article
This time, we took the time to learn more about what you need to know before filing an insurance claim.
By referring to the contents summarized this time, I think you have learned what actual cost insurance is, what documents are needed when making a claim, and how to make a claim. It may be a little annoying and difficult, but I hope you don’t just ignore this and apply to receive a refund for your hospital expenses.