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Insurance Reimbursement vs Non-Reimbursement

MISBLOC (Medical Information Service with Blockchain) is a medical service ecosystem which is based on blockchain technology. MISBLOC offers a sustainable and efficient medical service ecosystem by providing reliable medical information to patients, medical institutions, and public institutions in the Big Data era.

Hi there! In today’s post, we are going to continue providing interesting and useful pieces of educational content that will be helpful if you reside in South Korea. We hope that this post will be beneficial for you, and you will be able to gain knowledge by reading this content. In this post, we will define the difference between reimbursable and non-reimbursable insurance coverage items.

The separation of reimbursement & non-reimbursement

The standard that divides reimbursement and non-reimbursement in insurance coverage is something called the “treatment purpose.” Diseases that can interfere with your daily life, harm your health, or even threaten your life if you don’t get treatment are eligible for reimbursement claims. On the other hand, diseases that do not affect your daily life or require treatment are subject to non-reimbursement, and thus cannot be covered by your insurance.

The difference between reimbursement & non-reimbursement

Medical items covered by health insurance benefits are automatically reimbursed, while items that are not covered by insurance are non-reimbursed. For items covered by health insurance, only part of the medical expenses are paid by the patient. For non-reimbursed items, patients must pay the full amount.​

Hospital reimbursed expenses are not 100% covered, and thus 30% are usually paid by the patient and 70% by the Korean Health Insurance Corporation. The hospital will charge 70% of the hospital fee to the KHIC directly. The Health Insurance Review and Assessment Service sets the amount all hospitals are legally obliged to pay. Therefore, you can get the same type of treatment at any hospital when you receive treatment for a reimbursable item. However, the self-burden rate, which is a proportion of the patient’s medical expenses, depends on the size of the hospital as well. ​

For instance, the self-burden rate is 30% at a parliamentary level hospital, 40% at a primary hospital, 50% at a general hospital, and 60% at a senior general hospital. As you can see, the insurance coverage shrinks as the size of the hospital goes up which increases the self-burden rate.

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