개정 보험업법상 실손의료보험금 청구 간소화 방안에 대한 검토

As the need for improvement in the claim process for actual loss insurance was recognized, the National Human Rights Commission of Korea recommended in 2009 the improvement of the system to realize the computerization of actual loss insurance claims. Since then, discussions have been held to establish a plan to simplify the claim process for actual loss medical insurance, and accordingly, amendments to the Insurance Business Act were proposed. Finally, the Insurance Business Act was revised to establish a plan to simplify the claim process for actual loss medical insurance. Since insurance services can be seen as having a significant impact on the future of the insurance industry, they can never be neglected, so it is highly desirable that the Insurance Business Act was revised to realize the simplification of the claim process for actual loss insurance. The purpose of the revision of the Insurance Business Act is to practically enhance the benefits for insurance consumers by adopting electronic transmission methods, thereby resolving the inconvenience of paper document issuance and insurance claim procedures. In order for the computerization of actual loss insurance claims to proceed smoothly in line with the purpose of the revision, the computer system must be established as soon as possible. To this end, the medical community and insurance companies should mutually consult on the establishment and operation of an actual loss insurance claim computer system, regardless of their interests, and make efforts to ensure that the computerization of actual loss insurance claims proceeds smoothly. The transfer agency should not be determined by considering the interests of medical organizations or insurance companies, but should be determined by considering the convenience of the policyholder and the direction of maintenance and development of actual loss medical insurance. The Review and Assessment Service is an organization that has the ability to prevent excessive treatment resulting from the introduction of actual loss medical insurance. Considering this, if the Review and Assessment Service is designated as a transfer agency and insurance claim review agency, it is expected to have the effect of preventing indiscriminate treatment recommendations by medical institutions and increases in actual loss medical insurance premiums.