실손의료보험 청구체계 개선방안에 관한 연구 - 보험업법 개정안을 중심으로 -

Abstract

The fundamental reason why insurance consumers do not claim insurance money even after purchasing private health insurance is because the claim process is too difficult and complicated. Therefore, if the claim process for private health insurance would be simplified, the claim for private health insurance will be actively made. Despite much effort, the main reason for the failure to simplify the claims process for private health insurance was the conflict with existing Medical Law and strong opposition from stakeholders, including the medical community. However the issue of simplifying the claim process for private health insurance needs to be considered with the interest of insurance consumers. If the claims process for private health insurance would be simplified, the claims ratio will increase, which could greatly contribute to reducing the burden of medical expenses for insurance consumers. It is only natural for insurance consumers to pay a legitimate premium and receive a legitimate insurance payment from insurance companies in the event of an insurance accident. It is undesirable for these rights to be obstructed or virtually violated by the complexity of the claims process, given the social role and function of insurance. In this thesis, I will deal with the current status of private health insurance and the simplification of insurance claim procedures. In particular, I will analyze the main contents of amendments to the Insurance Business Law, which was recently submitted to the 21th National Assembly, and present problems and improvement measures.