#499. 5세대 실손 올해 하반기 출시! 최종안 확정됐어요! [반값 보험료 만들기 499]

Summary

The video explains the key changes in the 5th generation of a medical insurance plan, focusing on reducing premiums while enhancing coverage for severe medical conditions. It highlights the shift from broad non-essential treatment coverage to prioritizing critical care such as cancer, heart disease, and rare conditions. Key changes include the removal of mandatory re-entry for earlier policyholders, the introduction of new premium caps, and a shift in cost-sharing between policyholders and insurance. The reform aims to provide more affordable and relevant coverage while ensuring that those with serious health needs are well-supported.

Takeaways

• 😀 The 5th generation of 실손보험 (voluntary health insurance) will focus on reducing premiums while ensuring more targeted and helpful coverage for essential medical services and serious illnesses.
• 😀 The goal of the new system is to lower premiums by 30-50% and provide coverage that is truly necessary, helping to ease the financial burden on policyholders.
• 😀 Essential treatments (급여) will remain largely unchanged, with a 20% cost responsibility for policyholders, while coverage for non-essential treatments (비급여) will be reduced significantly.
• 😀 The automatic transition to the 5th generation of 실손보험 will occur for those who have signed up for the second to fourth generations of this insurance (from 2013 to 2024).
• 😀 Serious conditions like cancer, heart disease, and other critical illnesses will see expanded coverage in the 5th generation, with annual limits of 500,000 KRW for treatments at top-tier hospitals.
• 😀 For non-essential treatments, policyholders will have to pay a larger share of the costs, with self-payments increasing by up to 50% for outpatient services.
• 😀 The new system introduces a cap of 500,000 KRW for serious illness coverage at higher-tier hospitals, whereas the previous system had no such limit for these treatments.
• 😀 Early policyholders (1st and 2nd generation) will not be forced to transition to the 5th generation; they can choose whether to remain with their current plan or switch.
• 😀 New policies will cover maternity and childbirth as part of essential treatments, something not covered in previous generations.
• 😀 Non-essential treatments such as cosmetic surgery, certain therapies, and experimental treatments will no longer be covered, leading to reduced benefits in these areas.

Q & A

What is the main goal of the 5th generation of health insurance in South Korea?

The primary goal of the 5th generation of health insurance is to lower premiums while ensuring that essential medical care, especially for critical conditions, is adequately covered. It aims to make health insurance more affordable while reducing the coverage for non-essential treatments.

How does the 5th generation of health insurance differ from the 4th generation in terms of premiums?

The 5th generation offers lower premiums compared to the 4th generation, reducing the financial burden on policyholders. However, the reduction in premiums comes with a decrease in coverage for non-essential medical treatments.

What changes will the 5th generation bring to coverage for critical versus non-critical conditions?

The 5th generation will provide better coverage for critical conditions, such as cancer, heart diseases, and rare diseases, ensuring sufficient support for urgent and long-term care. Non-critical treatments will see a reduction in coverage, especially for less severe conditions like minor surgeries or physiotherapy.

How will the new insurance system affect early adopters of the insurance plan, such as those in the 1st and 2nd generations?

Early adopters in the 1st and 2nd generations (those who signed up before 2013) will not be automatically transitioned into the 5th generation. Instead, they will have the option to voluntarily transition to the new system, without being forced into the change.

What are the key differences in self-payment for treatments under the 5th generation of health insurance?

Under the 5th generation, the self-payment rule has been modified. If treatment costs exceed a certain threshold, policyholders will be responsible for a larger portion of the cost. Additionally, the reimbursement for treatments at specific high-cost hospitals will be capped.

Will treatments like cosmetic surgeries and experimental therapies be covered under the new insurance plan?

No, treatments like cosmetic surgeries and experimental therapies, which are not covered under the basic health insurance system, will not be reimbursed under the 5th generation health insurance.

What is the role of health insurance in reducing the financial burden on policyholders under the new plan?

The 5th generation health insurance aims to reduce financial burdens by lowering premiums, especially for essential medical care. This helps to make healthcare more affordable for the general population while focusing on covering critical conditions, which are more likely to cause high medical costs.

How will the transition to the 5th generation insurance system be implemented?

The transition to the 5th generation will begin in the second half of 2025. Existing policyholders will be encouraged to retain their current plans until then, with the option to switch to the new system when it becomes available.

What will be the impact on non-critical treatments under the 5th generation health insurance?

Non-critical treatments will see a significant reduction in coverage under the 5th generation. For example, insurance payments for minor surgeries, physiotherapy, and other non-essential treatments will be much lower or even excluded from the coverage.

What is the expected impact of the 5th generation on healthcare providers and medical institutions?

Healthcare providers, especially those dealing with non-critical conditions, might see fewer reimbursements as a result of the reduced coverage for non-essential treatments. However, institutions focused on critical care, such as hospitals specializing in cancer or heart conditions, will benefit from better insurance coverage under the new plan.