韩国第五代实损医疗保险上市三个月累计18.3万件，但老保单自主切换仅约15%

South Korea's fifth-generation indemnity health insurance, designed with lower premiums, drew more than 183,000 policies in the three months since its launch, but only about 15% of that total came from existing policyholders who chose to switch on their own. Older-generation subscribers facing heavy premium burdens have begun to move, but reduced coverage for treatments outside the national health insurance system and higher out-of-pocket costs are cited as obstacles to switching.
Inflows into fifth-generation indemnity policies at nine major non-life insurers totaled 183,218 from the May launch through the end of July, according to financial industry sources on the 26th. New sign-ups accounted for 134,315, or 73.3% of the total. Policies switched by first- through fourth-generation subscribers on their own initiative numbered 27,474, or 15.0%, while re-enrollments by fourth-generation policyholders reaching maturity totaled 21,429, or 11.7%.
Indemnity health insurance is divided into five generations based on when the products were sold and how coverage is structured. The fifth generation cut coverage for non-critical treatments outside the national health insurance system and set premiums about 30% below the fourth generation and at least 50% below the first and second. In exchange, the out-of-pocket rate for non-critical uncovered treatments rose to 50%, and manual therapy and non-covered injections were excluded from coverage.
Monthly inflows have risen since the launch, but fifth-generation policies in force accounted for just 0.6% of all indemnity policies in force at the end of July. "Demand for switching is increasing, centered on older-generation subscribers who face large premium burdens," an industry official said. "But older indemnity policies have broad coverage, so it is hard to switch based on premiums alone."
Inflows from fourth-generation policies reaching their re-enrollment cycle also began last month. Fourth-generation indemnity insurance, launched in July 2021, requires policyholders to go through re-enrollment into whichever product is on sale at the time once the five-year cycle comes around. As of the 13th of this month, 37,456 of the 76,989 policies due for re-enrollment had completed the application process. "Applications have been rising steadily as the vacation season ends," an industry official said. "Some policyholders are understood to have canceled their indemnity policies midterm rather than re-enroll."
Behind the push to establish the fifth generation are a deteriorating loss ratio and premium burdens. Since sales began in 1999, indemnity insurance has been overhauled four times over excessive medical use driven by low out-of-pocket costs and over premium increases. Insurance operations posted a loss of 1.87 trillion won last year, and the incurred loss ratio stood at 101.0%, above the 85% break-even point. The cumulative premium increase from 2022 through this year reaches 46.3%.
The older the generation, the heavier the use of treatments outside the national health insurance system. Spending per person on such treatments last year came to 440,000 won for the first generation and 350,000 won for the second, higher than 270,000 won for the third and 210,000 won for the fourth. In response, financial authorities will introduce a switching discount from November that gives early first- and second-generation subscribers a 50% premium discount for three years if they move to the fifth generation.