This English version is provided for the purpose of reference only. If there is a
difference of interpretation between the original Korean text and this English
version, The Korean text shall prevail.
Chapter 1 Effect and Maintenance of the Contract
Article 1 (Effect of the Contract)
¨ç An insurance contract comes into effect upon application by a would-be Policyholder and
subsequent acceptance by the insurance company ("Insurance Contract" to be referred
hereinafter as "Contract," "Insurance Policyholder," as "Policyholder," and "Insurance
Company," as "Company").
¨è If the Insured (Covered Person) does not qualify for the Contract, the Company may refuse
to accept or may accept after imposing additional conditions (e.g., limit in the subscription
amount, exemption from certain coverage, reduction in insurance money, or imposition of
extra insurance premiums).
¨é Upon receiving an application and the first installment of the insurance premium, the
Company shall accept or refuse on the same day with the date of application for a contract
that does not require diagnosis and within 30 days of the date of diagnosis (in case of
reexamination, the final examination day) for a diagnosis-based contract (hereinafter
referred to as ¡°Check Contract¡±). In case it accepts the application, the Company shall give
the insurance policy (insurance certificate). If there is no notice of acceptance or refusal
within 30 days, however, the application is deemed to have been accepted.
¨ê If the Company refuses to accept the application after receiving the first installment of the
insurance premium, it shall notify the Policyholder of its refusal and return the amount
received from the Policyholder together with interest equal to the amount calculated by
applying to the fixed deposit the interest rate announced by the Korea Insurance
Development Institute + 1% compounded annually for the period of holding the insurance
premium. In case the Policyholder paid the first installment of the insurance premium with
a credit card, but the Company refuses to accept the Contract, the Company shall cancel
the credit card sales and pay no interest.
Article 2 (Cancellation of Application)
¨ç The Policyholder may cancel the application within 15 days of the date of application. Note,
however, that this does not apply to cases of diagnosis-based insurance, (one treated as)
group contract, or contract with term of less than 1 year. In case of a Contract (limited to a
contract with term of not less than 1 year) via communication medium such as telephone,
post, or computer (hereinafter referred to as ¡°Telemarketing Contract¡±), the application
may be canceled within 30 days of the date of application.
¨è Upon receiving a notice of cancellation, the Company shall return within 3 days the
insurance premium received plus interest announced by the Korea Insurance
Development Institute compounded annually and applied to the fixed deposit for the period
starting from the next day of the return due date to the date the premium was returned. In
case the Policyholder cancels the application but has paid the first installment of the
insurance premium with a credit card, the Company cancels the credit card sales and pays
no interest.
¨é In case reasons for the payment of insurance money had already occurred but the
Policyholder has not known the occurrence of such, the cancellation of the application
does not take effect.
Article 3 (Presentation of the Provisions and Duty to Explain)
¨ç When the Policyholder applies, the Company shall present the insurance provisions and
the Policyholder¡¯s copy of the application form (copy of the application) and explain its key
contents to the Policyholder. In case of a Telemarketing Contract, however, one of the
following methods may be used by the company with the consent of the Policyholder:
1. Method of electronically sending the provisions and the Policyholder¡¯s copy of the
application form (copy of the application) such as optical recording medium or email; in
this case, the Policyholder shall be deemed to have been given the corresponding
provisions and the Policyholder¡¯s copy of the application form (copy of the application)
when he/she or his/her delegate receives the medium or the email
2. Method of having the Policyholder read or download the provisions and its explanation
(document explaining the key contents of the provisions) at a cyber mall (virtual store
that is set up to enable insurance trade using a computer); in this case, the Policyholder
is regarded to have been given the corresponding provisions when he/she is confirmed
to have read or downloaded the provisions and its explanation.
3. Method of explaining matters necessary for the conclusion of the Contract, such as the
contents of the application, payment of the insurance premium, insurance period, duty to
disclose prior to the conclusion of the Contract, and key contents of the provisions by
telephone; in this case, the Policyholder is regarded to have been given the explanation
of the key contents of the provisions by recording the answers and confirmations from
him/her.
¨è If the Company fails to present the provisions and the Policyholder¡¯s copy of the
application form (copy of the application) at the time of application or to explain its key
contents to the Policyholder as prescribed in Clause ¨ç , Article 3 herein, or in case the
Policyholder does not sign the application in his/her own hand [(including affixes his/her
personal seal) and electronic signature certified by a certificate institute as per Clause ¨ð
Article 2 of the Digital Signature Act], the Contract may be canceled within 3 months of the
date of the Contract. In case of (one treated as) group contract, the application may be
canceled within 30 days of the date of application.
¨é Notwithstanding Clause ¨è , Article 3 herein, a signature in the Policyholder¡¯s own hand
may be omitted when the Contract is concluded via telephone and any of the following
conditions are fulfilled, and the Policyholder is deemed to have been given the
Policyholder¡¯s copy of the application form (copy of the application) when the confirmation
letter as documentation of the content of the voice recording as per item 3, Clause ¨ç,
Article 3 herein is received:
1. In case of a Contract wherein the Policyholder, the Insured (Covered Person), and the
Beneficiary of insurance (recipient of insurance money; hereinafter referred to as
¡°Beneficiary¡±) are the same person
2. In case of a Contract wherein the Policyholder and the Insured (Covered Person) are the
same person and the Beneficiary is the legal heir of the Policyholder
¨ê In case the contract is canceled in accordance with Clause ¨è , Article 3 herein, the
Company shall return the insurance premium received from the Policyholder together with
the interest incurred for the period of holding the premium at the rate applied to the fixed
deposit as announced by the Korea Insurance Development Institute compounded
annually.
Article 4 (Termination of the Contract)
Under any of the cases described below, the Contract shall be void, and the insurance
premium that has been paid shall be returned. If the termination is attributable to the
negligence or fault of the Company, or the Company has recognized -- or could have known ?
that the Contract is not valid but has not returned the insurance premium, the Company shall
return the insurance premium received plus interest at the rate announced by the Korea
Insurance Development Institute compounded annually and applied to the fixed deposit for
the period starting from the next day of the date the premium was supposed to be returned to
the date the premium was actually returned.
1. The Company fails to obtain the written consent of the Insured (Covered Person) by the
time the Contract stipulating that death of another person is one of the reasons for
payment is concluded. Note, however, that this shall not apply in case of a group
contract with the entire or a part of the group as the Insured (Covered Person) in
accordance with the regulation of the group
2. In case of a death of a person younger than 15 years, a person who is not of sound mind
or a weak-minded person
3. The age of the Insured (Covered Person) is more or less than the age specified in the
contract at the time of contract conclusion. Note, however, that this shall not apply if the
Insured (Covered Person) has already reached the specified age when the Company
discovers the error in the age, but exclusion from the case of a person younger than 15
years as per Clause ¨è , Article 4 herein is not allowed.
Article 5 (Change in Contents of the Contract, Etc.)
¨ç The Policyholder may change the following items with approval from the Company, in
which case the written approval shall be sent or written at the back of the insurance policy
(insurance certificate):
1. Type of insurance
2. Policy term
3. Payment cycle, collection method, and payment period
4. The Policyholder and the Insured (Covered Person)
5. Insurance money and other contents of the contract
¨è The Policyholder may change the Beneficiary without approval from the Company. If the
Policyholder fails to notify the Company when he/she changes the Beneficiary, however,
the Beneficiary may not defy the Company by invoking his/her right after the change.
¨é If the Policyholder requests for the change in insurance type after having a valid Contract
for more than 1 year from the date of the first installment payment of the insurance
premium, the Company shall change the type of insurance in accordance with the
methods defined in business rule book.
¨ê If the Policyholder wishes to reduce the insurance money in accordance with Item 5,
Clause ¨ç , Article 5 herein, the Company shall regard the reduced part as terminated and
shall return the paid insurance premium, if any, to the Policyholder in accordance with
Article 29 (Return of Insurance Premium).
¨ë If the Policyholder wishes to change the Beneficiary in accordance with Clause ¨è , Article 5
herein, written consent from the Beneficiary is required before a reason for insurance
payment occurs
Article 6 (Voluntary Termination by the Policyholder and Termination of Written Consent
by the Insured (Covered Person))
¨ç The Policyholder may terminate the contract anytime before the expiration of the contract.
In this case, the Company shall return the paid insurance premium, if any, to the
Policyholder in accordance with Article 29 (Return of Insurance Premium).
¨è For the Contract wherein a death serves as reason for insurance payment in accordance
with Article 4 (Termination of Contract) herein, the Insured (Covered Person) who has
provided written consent may cancel the consent for the future anytime the contract is
valid. When the Contract is terminated due to the cancellation of the written consent, the
Company shall return the paid insurance premium, if any, to the Policyholder in
accordance with Article 29 (Return of Insurance Premium).
¨é If insurance money is paid due to the occurrence of reason for payment, but the face
amount has not been reduced, the Policyholder may terminate the contract even after the
occurrence of the reason for payment of insurance money.
Article 7 (Expiration of the Contract)
If the reasons defined in these provisions for insurance payment are no longer expected to
occur because the Insured (Covered Person) is deceased, this Contract shall no longer be
valid.
Article 8 (Insurance Age and Other Matters)
¨ç In these provisions, the age of the Insured (Covered Person) shall be the insurance age. In
case of Clause ¨è , Article 4 (Termination of the Contract) herein, however, the actual age
shall be applied.
¨è The insurance age is calculated by omitting the months from the actual age as of the
effective date in case of less than 6 months and by counting 6 or more months as 1 year.
The Insured (Covered Person) is considered to turn one year older on the effective date of
the Contract every year.
¨é If the written record of the age or gender of the Insured (Covered Person) is not correct,
the insurance money and the insurance premium shall be changed to the one
corresponding to the corrected age or gender.
¡¼Sample calculation of the insurance age¡½
Date of birth: Oct. 02, 1988 as of the present day (effective date): Apr. 13, 2009
¢¡ Apr. 13, 2009 - Oct. 02, 1988 = 20 years, 6 months, and 11 days = 21 years old
Chapter 2. Payment of Insurance Premiums and Other Matters
Article 9 (1 st Installment of Insurance Premiums and Beginning of the Company's
Responsibility)
¨ç The responsibility of the Company in accordance with these provisions begins when the
Company receives the 1 st installment of the insurance premium (in case of electronic
transfer or payment by credit card, when the information needed for the request for
electronic transfer or approval of credit card sales is provided; for the case wherein
electronic transfer or payment by credit card is impossible due to the Policyholder¡¯s fault,
1 st installment is deemed not to have been made). If the Company has received the 1 st
installment of the insurance premium at the time of application and has accepted the
application, the responsibility of the Company in accordance with this provisions begins
once the Company receives the 1 st installment of the insurance premium (in these
provisions, the date the Company receives the 1 st installment shall be called ¡°Beginning of
Coverage (Beginning of Responsibility)¡±; the Beginning of Coverage (Beginning of
Responsibility) is considered the effective date).
¨è In case a reason for insurance payment occurs after the Company has received the 1 st
installment of the insurance premium but before accepting the application, the Company
shall have responsibility according to these provisions.
¨é Notwithstanding Clause ¨è , Article 9 herein, the Company shall not be held liable under
any of the following cases:
1. The Company proves that the contents of the notice or medical diagnosis presented to
the Company by the Policyholder or the Insured (Covered Person) as per Article 18
(Duty to Disclose Prior to Contract Conclusion) triggered the occurrence of the cause of
the payment of insurance money.
2. The Company cannot be held responsible as per Article 20 (Violation of the Duty to
Disclose).
3. In case of a diagnosis-based contract, the Insured has failed to get a diagnosis until the
reason for payment of insurance money occurs.
¨ê In case the contract is renewed, the responsibility according to Clauses ¨ç and ¨è , Article 9
herein begins when the responsibility as per the existing contract ends.
¨ë Notwithstanding the provisions of Clause ¨ç , Article 9 herein, the Company shall not be
held liable for accidents occurring before the Insured (Covered Person) leaves the place of
residence or after he/she arrives at his/her place of residence.
¨ì Notwithstanding the provisions of Clause ¨ç , Article 9 herein, the period of coverage shall
automatically be extended for another 24 hours in case a transport vehicle where the
Insured (Covered Person) is a passenger including airplanes or ships arrives late even
though it is scheduled to arrive at the final destination by the last day of the period of
coverage as recorded in the Insurance Policy (Insurance Certificate).
¨í Regarding Clause ¨ì , Article 9 herein, in case the airplane where the Insured (Covered
Person) is a passenger is placed under unlawful control by the 3rd party or is bound by
public power, the Company¡¯s period of liability shall be extended for as long as it takes the
Insured (Covered Person) to return to normal status of travel or by the time deemed
appropriate by the Company.
Article 10 (Payment of Insurance Premium After the 2 nd Installment)
The Policyholder shall pay the insurance premium after the 2 nd Installment on the promised
date of payment (hereinafter referred to as ¡°Due Date¡±), and the Company shall issue a
receipt if the Policyholder has paid the premium. If payment is made via a financial institution
(including post office), however, documentary evidence from the financial institution may
substitute the receipt.
Article 11 (Summons (Calls) in Case of Delay in Payment and Termination of the
Contract)
¨ç In case the Policyholder has not paid the insurance premiums after the 2 nd Installment by
the Due Date, and the premium is consequently overdue, the Company shall set more
than 14 days (7 days if the period of coverage is less than 1 year) as the period of
summoning (calling) (if the last day of summoning is Saturday or a holiday, the period
ends on the immediately succeeding weekday) and notify the Policyholder (if the contract
is for another person, the specific Beneficiary shall be included) by post (such as via
registered mail), telephone (voice recording), or electronic document that the premium
shall be paid within the period of summoning (calling), and the contract shall be terminated
the day after the end date of summoning (calling) if the premium has not been paid by the
end date of summoning (calling). In case a reason for insurance payment has occurred
before the termination, however, the Company shall make compensation accordingly.
¨è In case the Company wishes to direct the summoning (calling) by electronic document in
accordance with Clause ¨ç herein, it shall send the electronic document after obtaining the
consent of the Policyholder and on the condition of confirmation of receipt. The electronic
document shall not be considered received until the Policyholder confirms the receipt of
the corresponding electronic document. In case the electronic document is proven not to
have been received, the Company shall set the period of summoning (calling) in
accordance with Clause ¨ç herein and notify the Policyholder (if the Contract is for another
person, the specific Beneficiary shall be included) again by post (such as registered mail)
or telephone (voice recording).
¨é If the Contract has been terminated in accordance with Clause ¨ç , Article 11 herein, the
Company shall return the paid insurance premium, if any, to the Policyholder in
accordance with Article 29 (Refund of Insurance Premium).
Article 12 (Restoration (Recovery of Effect) of Contract that is Terminated Due to the
Delay in Payment)
¨ç If the Contract is terminated in accordance with Article 11 (Summons (Calls) in Case of
Delay in Payment and Termination of the Contract), but the Policyholder has not received
the refund according to Article 29 (Refund of the Insurance Premium), the Policyholder
may apply for the restoration (recovery of effect) of the Contract in accordance with the
procedure defined by the Company. If the Company accepts the application, the
Policyholder shall pay the overdue insurance premium up to the date the application is
made for the restoration (recovery of effect) of the contract plus the amount calculated by
applying the rate set by the Company for each good, which is within the range of the fixed
deposit rate announced by the Korea Insurance Development Institute+ 1%.
¨è If the Contract is restored (recovery of effect) in accordance with Clause ¨ç , the provisions
of Article 1 (Effect of Contract), Article 9 (1 st Installment and Beginning of Period of the
Company's Responsibility), Article 18 (Duty to Disclose Prior to Contract Conclusion),
Article 20 (Effect of Violation of Duty to Disclose), and Article 22 (Contract Concluded by
Fraud) shall be applied.
Article 13 (Special Restoration (Recovery of Effect) of Contract that is Terminated Due to
Execution, Etc.)
¨ç In case of a Contract for another person, and the Contract is terminated due to execution,
foreclosure, and disposition of national tax and local tax for the Policyholder¡¯s right to claim
a refund in accordance with Article 29 (Refund of Insurance Premium), the Company shall
notify the Beneficiary that the Beneficiary (Recipient of insurance money) may apply for
Special Restoration (Recovery of Effect) of the Contract with consent from the
Policyholder if the Beneficiary pays the amount paid by the Company to the creditors due
to the termination and changes the title of the contract to the Beneficiary in accordance
with Clause ¨ç , Article 5 (Change in Content of the Contract, Etc.) herein.
¨è The company shall accept the application for the transfer of the Policyholder¡¯s title and
Special Restoration (Recovery of Effect) of Contract as per Clause ¨ç , Article 13 herein,
and the Contract shall be specially restored (Recovery of Effect) as of the time of
application.
¨é The Company shall notify the Beneficiary (Recipient of insurance money) in accordance
with Clause ¨ç , Article 13 herein. If the Beneficiary (Recipient of insurance mone y) is the
legal heir, however, the Company may send a notice in accordance with Clause ¨ç , Article
13 herein to the Policyholder.
¨ê The Company shall send a notice in accordance with Clause ¨ç , Article 13 herein within 7
days of the date the contract is terminated. In case the notice from the Company arrives
after 7 days, and the Beneficiary (Recipient of insurance money) applies for the transfer of
the Policyholder¡¯s title and Special Restoration (Recovery of Effect) of Contract according
to Clause ¨ç , Artic le 13 herein, however, the Contract shall be specially restored
(Recovery of Effect) after 7 days from the date of termination.
¨ë The Beneficiary (Recipient of insurance money) may execute the procedure according to
Clause ¨ç , Article 13 herein within 15 d ays of receipt of the notice (if the Policyholder has
been notified in accordance with Clause ¨é , Article 13 herein, it shall mean the date of the
Policyholder¡¯s receipt of the notice).
Chapter 3. Payment of Insurance Money
Article 14 (Kinds of Insurance Money and Reasons for Payment Thereof)
¨ç If any of the reasons for payment of insurance money occurs on the part of the Insured
(Covered Person) under any of the following cases during travel as entered in the
insurance policy (insurance certificate), the Company shall pay the agreed upon insurance
money to the Beneficiary of the insurance (Recipient of insurance money).
1. In case the Insured (Covered Person) has died as a direct result of an injury or injuries
sustained during the insurance period (i.e. bodily injury or injuries (excluding physical
aids, e.g., artificial arm/hand, artificial leg, artificial eyes, or denture, but including any
artificial organ, any partial denture, etc. implanted in his/her body that replaces the
relevant natural body function) due to a sudden, unexpected external accident during the
insurance period, hereinafter referred to as an ¡°injury or injuries¡±) (excluding death due to
a disease): death benefit
2. In case the Insured (Covered Person) has developed a disability covered by any of the
disability payment rates specified in the Disability Classification Table (see [Attachment
7]; the same shall apply hereinafter): sequela-related disability benefit (amount of money
calculated by multiplying the payment rate specified in the Disability Classification Table
by the insured amount subscribed to)
¨è 'During overseas travel' as per Clause ¨ç herein pertains to the following:
from the time the Insured (Covered Person) departs from his/her place of residence for
travel purposes until he/she finishes traveling and arrives at his/her place of residence.
Article 15 (Detailed Stipulations Concerning the Payment of Insurance Money)
¨ç Item 1, Article 14 (Kinds of Insurance Money and Reasons for Payment Thereof) covers
the case of the disappearance of the Insured (Covered Person) being declared because
the Insured (Covered Person) has been missing during the insurance period. In case the
Insured (Covered Person) is officially recorded dead in the Family Relation Register
following a report of death by a government office that officially acknowledges such death
as attributable to any of the reasons or injuries prescribed in Clause 2, Article 27 of the
Civil Act, including ship sinking, airplane crash, etc., the insured (Covered Person) shall be
considered to be dead when the above accidents occur.
¨è Notwithstanding Item 2, Article 14 (Kinds of Insurance Money and Reasons for Payment
Thereof), for a temporary disability -- although not the fixed or permanent type -- occurring
for a period of five (5) years or more after the injuries are completely healed, the Company
shall pay insurance money calculated by multiplying 20% of the specified payment rate of
the Disability Classification Table by the insured amount subscribed to.
¨é If the disability payment rate under Item 2, Article 14 (Kinds of Insurance Money and
Reasons for Payment Thereof) has not been decided until 180 days from the date of injury,
the payment rate for the anticipated permanent physical condition based on the doctor's
diagnosis on the 180th day shall be applied. In case the disability is aggravated during the
period of coverage after the decision of the disability payment rate (in case the contract
has become ineffective, the period shall not exceed two years from the date of injury for a
contract with insurance period of 10 years or over and one year for a contract with
insurance period of less than 10 years), however, the payment ratio based on the
aggravated disability shall be applied. A separately prescribed period for deciding the
disability as shown in the Disability Classification Table shall apply, if any.
¨ê The amount to be paid for sequela-related disability other than those shown in the
Disability Classification Table shall be decided based on the degree of disability classified
in the Disability Classification Table regardless of occupation, age, social status, and
gender of the Insured (Covered Person). If the sequela-related disability does not qualify
for the minimum payment rate for the disability shown in the Disability Classification Table,
however, no Sequela-related Disability Benefits shall be paid.
¨ë In case two (2) or more sequela-related disabilities develop from the same injury, the
payment rate of each disability shall be added and paid. Note, however, that separately
prescribed evaluation criteria for each body part as shown in the Disability Classification
Table shall apply, if any.
¨ì Notwithstanding the provisions of Clause ¨ë herein, in case two (2) or more disabilities
shown in the Disability Classification Table develop on the same part of the body, the
payment rate shall not be added; instead, the higher payment rate shall apply. Note,
however, that separately prescribed evaluation criteria for each body part as shown in the
Disability Classification Table shall apply, if any.
¨í If sequela-related disability occurs at least twice due to other injuries, the Company shall
decide the sequela-related disability payment rate on a case-to-case basis. In case the
sequela-related disability occurring on the same region and for which sequela-related
disability benefit has already been paid is aggravated, final sequela-related disability
benefit shall be paid after deducting the previously paid sequela-related disability benefit.
Note, however, that separately prescribed evaluation criteria for each body part as shown
in the Disability Classification Table shall apply, if any.
¨î In case the sequela-related disability prescribed in Clause 7 recurs on the same body part
of the Insured (Covered Person) with any of the following sequela-related disabilities,
sequela-related disability benefit covering the sequela-related disability falling under any of
the following shall be considered to have been paid, and final sequela-related disability
benefit shall consequently be paid after deducting from the sequela-related disability
benefit covering the final sequela-related disability the sequela-related disability benefits
considered to have been paid already:
1. Sequela-related disability that is not covered by the insurance for sequela-related
disability because such disability had developed due to causes occurring before the
coverage under this contract became effective
2. Sequela-related disability that is not considered to fall under Item 1 and is not covered by
the payment of sequela-related disability benefits under this contract or sequela-related
disability for which no sequela-related disability benefits had been paid
¨ï In case the Insured (Covered Person) and the Company fail to reach an agreement on the
disability payment rate for the Insured (Covered Person), they may designate a mutually
agreed upon third party and comply with the opinion of such third party. In this case, the
designated third party shall be one of the medical specialists belonging to a general
hospital as prescribed in Article 3 (Medical Institution) of the Medical Act, and the medical
expenses incurred in deciding the disability shall be paid in full by the Company.
¨ð The upper limit of sequela-related disability benefit due to an injury as payable by the
Company shall be the insured amount subscribed to
Article 16 (Reasons for Non-Payment of Insurance Money)
¨ç The Company shall not pay insurance money in case any reason for insurance money
payment occurs due to any of the following cases:
1. As intended by the Insured (Covered Person); note, however, that the Company shall
pay insurance money in case the Insured (Covered Person) has harmed himself/herself
while being unable to make decisions on his/her own due to psychosomatic disorder, etc.
2. As intended by the Beneficiary of the insurance (recipient of insurance money); in case
of other beneficiaries (recipients of insurance money) who receive a portion of the
insurance money, however, the total insurance money payable after deducting the part
originally claimable by the Beneficiary (recipient of insurance money) concerned shall be
paid to the other beneficiaries (recipients of insurance money)
3. As intended by the Policyholder
4. Pregnancy, childbirth (including one via caesarian operation), or puerperal period of the
Insured (Covered Person), except any of the reasons for payment of insurance money
as covered by the Company
5. War, use of armed forces by foreign countries, revolution, civil war, national incident, and
riot
¨è Unless agreed upon otherwise, the Company shall not pay the corresponding insurance
money in case of the occurrence of any of the reasons for payment of insurance money as
specified in Article 14 (Kinds of Insurance Money and Reasons for Payment Thereof)
during the performance of any of the following acts by the Insured (Covered Person) as
part of his/her job or as a social activity:
1. Specialist climbing (ascending or descending rock walls or ice ridges using a specialist's
climbing aids or other climbing activities requiring specialist techniques, experience, and
training), glider piloting, skydiving, scuba diving, hang-gliding, and other similar activities
2. Racing, exhibition, entertaining (including training for one of such activities) using a
motorboat, a car, or a motorcycle or test running of any of such vehicles (except in the
case of occurrence of any of the reasons for payment of insurance money during test-
running on a public road)
3. Onboard a ship as a profession, e.g., crewmember, fisherman, boatman, etc.
Article 17 (Expiration of the Right to Claim)
If the rights to claim insurance money, insurance premiums, surrender value or dividend are
not exercised for two (2) years, their prescription thereof shall be extinguished.
¡¼Expiration of the Right to Claim¡½
Expiration of the Right to Claim' refers to the period during which one can exercise one¡¯s
given right, otherwise such right may be invalidated at the end of the period. As a common
insurance practice, if the insurance money is not claimed within two (2) years of the date
the cause of the payment of insurance money occured, the insurance money shall no
longer be paid.
Chapter 4. Duty to Disclose Prior to Contract Conclusion and Other Matters
Article 18 (Duty to Disclose Prior to Contract Conclusion)
The Policyholder and the Insured (Covered Person) or their representative should provide
true and correct information to the best of their knowledge (hereinafter referred to as ¡°Duty to
Disclose Prior to Contract Conclusion,¡± which is the same as Duty to Notify in commercial
laws) when filling out the application form at the time of application (at the time of medical
examination in the case of a diagnosis-based contract). In the case of a diagnosis-based
contract, however, resources that may serve as grounds for the judgment of health -- such as
a medical report acquired at the company level or individually from a general hospital or a
hospital pursuant to Article 3 of Medical Service Law (Medical Institutions) -- may replace the
medical examination.
¡¼Duty to Disclose Prior to Contract Conclusion¡½
As an obligation specified in Article 651 of the Commercial Act, the ¡®Duty to Disclose Prior
to Contract Conclusion¡¯ requires the Policyholder or the Insured (Covered Person) to
answer accurately the written questions of the company based on fact; otherwise, the
Policyholder or the Insured (Covered Person) may suffer from disadvantages such as the
cancellation of the contract and/or disapproval of insurance money payment.
Article 19 (Duty to Disclose After the Conclusion of the Accident Insurance Contract)
¨ç In case the Policyholder or the Insured (Covered Person) changes his/her occupation or duty
(including cases such as passenger-car driver changing his/her occupation or duty to a driver of a
car kept for business), or he/she begins to use a two-wheeled vehicle or a motorized bicycle, the
Policyholder or the Insured (Covered Person) shall immediately notify the Company.
¨è In case the risk is reduced according to Clause ¨ç, Article 19 herein, the Company shall
return the difference in the insurance premium. In case the risk increases due to the
intention of -- or gross negligence on the part of -- the Policyholder or the Insured
(Covered Person), the Company may request for an increase in insurance premium or
terminate the contract within 1 month of receipt of notice by the the Policyholder or the
Insured.
¨é If there is an increase in insurance premiums as per Clause ¨ç, Article 19 herein, and the
Company has charged the increase but the Policyholder has neglected the payment, the
Company may reduce the payment based on the proportion of the insurance rate applied
before the change of occupation or duty (hereinafter referred to as ¡°Rate Before Change")
to the insurance rate applied after the change of occupation or duty (hereinafter referred to
as ¡°Rate After Change"). In case the reason for payment of insurance money that occurred
is not related to the occupation or duty that has been changed, however, this provision
shall not apply.
¨ê In case the Policyholder or the Insured (Covered Person) fails to notify the Company of the
change of occupation or duty intentionally or due to gross negligence, and the Rate After
Change is higher than the Rate Before Change, the Company shall notify the Policyholder
or the Insured (Covered Person) within 1 month of recognizing the fact that the Coverage
shall be based on Clause ¨é, Article 19 herein and pay insurance money accordingly.
Article 20 (Effect of Violation of Duty to Disclose)
¨ç Under any of the following cases, the Company may terminate this Contract within 1 month
of recognizing the facts regardless of the occurrence of the reason for insurance payment:
1. The Policyholder or the Insured (Covered Person) or the representative thereof violates
Article 18 (Duty to Disclose Prior to Contract Conclusion) intentionally or due to gross
negligence, and the duty is the one that is important.
2. The duty to disclose after contract conclusion as specified in Article 19 (Duty to Disclose
After Accident Insurance Contract Conclusion) and in relation to the apparent increase
in risks has not been fulfilled.
¨è Notwithstanding the provisions of Item 1, Clause ¨ç , Article 20 herein, the Company shall
not terminate this Contract under any of the following cases:
1. The Company has known the fact at the time of conclusion of the contract or has not
known the fact due to negligence.
2. More than 1 month has passed since the Company has recognized the fact, or more
than 2 years (in case of a diagnosis-based contract, 1 year for a disease) have passed
with no reasons for insurance payment occurring.
3. Three years have passed from the date of conclusion of the contract.
4. The Company accepts the application of the Contract based on basic resources, which
may serve as grounds for the judgment of health (such as a copy of the medical report),
and reasons for the payment of insurance money occur due to matters specified in the
copy of the medical report, etc., (excluding the case wherein the Policyholder or the
Insured (Covered Person) intentionally put important information incorrectly in the basic
resources that he/she has submitted to the Company)
5. The insurance agent, etc., have not given the Policyholder or the Insured (Covered
Person) the opportunity to notify or have interrupted the notification of the truth. The
insurance agent, etc., have had the Policyholder or the Insured (Covered Person)
withhold information or have falsified the notice. In case the Policyholder or the Insured
(Covered Person) is recognized to have withheld information or to have falsified the
notice regardless of the insurance agent and another person¡¯s action, however, this
does not apply.
¨é If the termination of the Contract as per Clause ¨ç , Article 20 herein has been carried out
before the occurrence of the reason to pay insurance money, the Company shall return
the paid insurance premium, if any, in accordance with Article 29 (Refund of Insurance
Premiums) to the Policyholder.
¨ê If the termination of the contract as per Item 1, Clause ¨ç , Article 20 herein has been
carried out after the occurrence of the reason to pay insurance money, the Company shall
not pay insurance money and shall notify the Policyholder in writing of the reason the Duty
to Disclose is important as well as the violation of the Duty to Disclose and include the
statement ¡°You may raise objections if there is proof to the contrary.¡± In this case, the
Company shall return the paid insurance premium, if any, in accordance with Article 29
(Refund of Insurance Premiums) to the Policyholder.
¨ë If the termination as per Item 2, Clause ¨ç , Article 20 herein has been carried out after the
occurrence of the reason to pay insurance money, the Company shall pay insurance
money for the loss as per Clause ¨é or ¨ê , Article 19 (Duty to Disclose After Acci dent
Insurance Contract Conclusion) herein.
¨ì Notwithstanding Clause ¨ê or ¨ë , Article 20 herein, the Company shall pay insurance
money if the Policyholder or the Insured (Covered Person) proves that the violation of the
Duty to Disclose has not affected the occurrence of the reason to pay insurance money,
notwithstanding Clause ¨ç , Article 20 herein.
¨í The Company shall neither terminate the Contract nor refuse the payment of insurance
money on the grounds of violation of the Duty to Disclose for another insurance policy.
Article 21 (Termination due to Serious Reasons)
¨ç The Company may terminate the contract within 1 month of learning that any of the
following cases has occurred:
1. The Policyholder, the Insured (Covered Person), or the Beneficiary (Recipient of
insurance money) intentionally causes reasons for payment of insurance money to
occur.
2. The Policyholder, the Insured (Covered Person), or the Beneficiary (Recipient of
insurance money) intentionally indicates untruthful facts in documents related to the
claim of insurance money or forges or falsifies documents or evidences. In case
reasons for the payment of insurance money have already occurred, however, the
payment of insurance money shall not be affected..
¨è In case the Company terminates the contract in accordance with Clause ¨ç , Article 21
herein, the Company shall notify the Policyholder of the reason. The Company shall return
the paid insurance premium, if any, in accordance with Article 29 (Refund of Insurance
Premiums) to the Policyholder.
Article 22 (Contract by Fraud)
If the Company proves that the contract comes into effect under fraudulent circumstances
such as the Policyholder or the Insured (Covered Person) having passed the medical
examination by proxy or by taking drugs and subscribing to insurance by forging or falsifying
the medical examination report or by hiding the fact that he/she has been diagnosed with
cancer or Human Immunodeficiency Virus (HIV) before the application date, the Company
may terminate the contract within 5 years of the contract conclusion date (within 1 month of
the date of recognizing the fraud).
Chapter 5. Payment of Insurance Money and Other Matters
Article 23 (Notice of Change of Address)
¨ç In case of any change in the address or contact details of the Policyholder or the
Beneficiary (this applies to contracts on behalf of other persons), the Policyholder or the
Beneficiary shall immediately notify the Company accordingly.
¨è If the Policyholder or the Beneficiary fails to notify the Company of such change as
prescribed in Clause ¨ç , a notice sent by registered mail by the Company to the address
and/or contact details last known to the Company shall be construed to have reached the
Policyholder after the time that is generally required for arrival has lapsed.
Article 24 (Designation of Insurance Beneficiary (Recipient of Insurance Money)
The Policyholder may designate the Beneficiary (Recipient of Insurance Money). If not
designated, the Beneficiary (Recipient of Insurance Money) shall be either the successor of
the Insured (Covered Person) in the case of Item 1, Article 14 (Kinds of Insurance Money and
Reasons for Payment Thereof) or the Insured (Covered Person) in the case of Item 2 of the
same Article.
Article 25 (Designation of Representative)
¨ç In case there are two or more Policyholders or Beneficiaries, they shall respectively
designate a single representative. In this case, such representative shall act on behalf of
the other Policyholders or Beneficiaries.
¨è In case the whereabouts of the Policyholder or the Beneficiary designated as the
representative as set forth in Clause ¨ç are uncertain, or in case the Policyholders or the
Beneficiaries have failed to or are unable to designate their respective representative
notwithstanding the Company¡¯s request for such designation, the validity of any act
performed by the Company on any single person among the Policyholders or the
Beneficiaries shall also apply to the other Policyholders or the Beneficiaries.
¨é In case there are two or more Policyholders, they shall be jointly and severally liable.
Article 26 (Notice of Reasons for Payment of Insurance Money)
¨ç In case the Policyholder, the Insured (Covered Person), or the Beneficiary (Recipient of
Insurance Money) learns of the occurrence of any of the reasons for payment of insurance
money as set forth in Article 14 (Kinds of Insurance Money and Reasons for Payment
Thereof), he/she shall immediately notify the Company accordingly.
¨è In case the airplane or the ship boarded by the Insured (Covered Person), is missing or is
in distress, the Policyholder, or the Beneficiary (Recipient of Insurance Money) shall
immediately notify the Company accordingly.
Article 27 (Documents Required for Insurance Claims, etc.)
¨ç The Beneficiary (Recipient of Insurance Money) or the Policyholder must produce the
following documents when claiming insurance money or return of insurance premiums in
accordance with Article 29 (Return of Insurance Premiums):
1. Applications (Company-specified forms)
2. Certificate of accident (bill for medical checkup cost, death certificate, medical reports,
certificate of hospitalization, medical prescription (prescribing and dispensing fees),
and/or others)
3. Identification cards (identification cards issued by the government such as resident
registration card or driver¡¯s license with photo attached including certificates of official seal
impression in case the Policyholder is not the Beneficiary himself/herself)
4. Other documents required to receive insurance money and for submission by the
Beneficiary (Recipient of Insurance Money)
¨è If the certificate of accident is issued by a hospital or a medical practitioner as specified in
Item2 of Clause ¨ç, Article 20 herein, the hospital or the medical practitioner must be a
qualified local one conforming to Article 3 (Medical institution) of the Medical Service Act
or a foreign one who is deemed similarly qualified.
Article 28 (Payment of Insurance Money)
¨ç Upon receiving the documents specified in Article 27 (Documents Required for Insurance
Claims, Etc.), the Company shall issue receipts and pay insurance money within 3
business days of the date of receiving the documents.
¨è If the payment period prescribed in Clause ¨ç herein is expected to be delayed owing to
the need to investigate or verify the grounds for payment of insurance money, the
Company shall notify the Insured (Covered Person) or the Beneficiary (Recipient of
Insurance Money) of the detailed reasons and expected date of payment of insurance
money.
¨é In case additional investigation is being conducted pursuant to Clause ¨è herein, the Company shall
pay provisional insurance money equivalent to 50% of the insurance money as estimated by the
Company at the request of the Insured (Covered Person) or the Beneficiary (Recipient of
Insurance Money).
¨ê If it fails to pay insurance money within the payment period specified in Clause ¨ç herein,
the Company shall pay interest in the amount calculated by applying the interest rate to
the fixed deposit as announced by the Korea Insurance Development Institute
compounded annually covering the period starting from the next day to the day of payment
in addition to the insurance money.. If payment is delayed for reasons attributable to the
Policyholder, the Insured (Covered Person), or the Beneficiary (Recipient of Insurance
Money), however, no interest shall be paid for the relevant period.
¨ë The Policyholder, the Insured (Covered Person), or the Beneficiary shall extend his/her
cooperation regarding the written request for cooperation in an investigation conducted by
the Company through medical institutions, National Health Insurance Corporation, and/or
police pursuant to Article 20 (Effect of Violation of Duty to Disclose) and reasons for
payment of insurance money as set forth in Clause ¨è . If the Policyholder, the Insured
(Covered Person), or the Beneficiary (Recipient of Insurance Money) refuses to cooperate
in relation to such investigation without justifiable reasons, the Company shall not pay any
interest for the delayed payment of insurance money until such investigation is completed.
¡¼Definition¡½
¡®Business days¡¯ pertains to ordinary days excluding ¡°Saturdays,¡± ¡°Sundays,¡± ¡°legal
holidays set by the government,¡± and ¡°Labor Day.¡±
Article 29 (Return of Insurance Premiums)
¨ç In case this contract is canceled, the Company shall return the premiums as follows:
1. In case the contract is nullified or canceled for reasons other than those attributable to
the Policyholder, the Insured (Covered Person), or the Beneficiary, the full amount of the
premiums paid to the Company in case of nullification or premiums calculated on a daily
basis covering the remaining period in case of invalidation or cancellation shall be
returned.
2. In case the contract is nullified or canceled for reasons attributable to the Policyholder,
the Insured (Covered Person), or the Beneficiary, an amount from which the premiums
calculated based on the short-term rate (rates applicable for a period of less than 1
year) covering the period that already lapsed shall be deducted. Note, however, that the
premiums shall not be returned if the contract is nullified as intended by the Policyholder,
the Insured (Covered Person), or the Beneficiary (Recipient of Insurance Money) or by
gross negligence.
¨è In case a contract with insurance period of more than 1 year is nullified or invalidated, the
Company shall pay premiums covering the insurance year of the day of occurrence of
causes of such nullification or invalidation, or the insurance year of the day of cancellation
in accordance with the provisions of Clause ¨ç and pay the full amount of premiums
covering the insurance year thereafter.
Article 30 (Change of Method of Receiving Insurance Money)
¨ç The Policyholder (the Beneficiary (Recipient of Insurance Money) after the occurrence of
any of the reasons for payment of insurance money) may change the method of payment
of insurance money to payment in lump sum or payment in installments of all or part of the
insurance money as prescribed by the Company¡¯s Business Operating Manual.
¨è When paying the total insurance money in installments in accordance with Clause ¨ç , the
Company shall pay interest in the amount calculated by applying the interest rate to the
fixed deposit as announced by the Korea Insurance Development Institute compounded
annually in addition to the amount payable. When paying the installment payment amounts
in lump sum, however, the Company shall pay the amount discounted by applying the
interest rate to the fixed deposit as announced by the Korea Insurance Development
Institute compounded annually.
Article 31 (Exchange of Contract Information)
After obtaining agreement from the Policyholder or the Insured (Covered Person), the
Company may provide the following information to other companies (including persons to
whom business related to insurance is entrusted) and insurance-related organizations for use
as reference materials when entering into and managing the Contract. In this case, the
Company shall comply with the provisions of Clause ¨è , Article 16 (Limitation on Collection,
Investigation, and Handling) and Article 32 (Agreement on Providing and Utilizing Personal
Credit Information) of the Act on the Utilization and Protection of Credit Information and
Article 28 (Agreement on Providing and Utilizing Personal Credit Information) of its
Enforcement Decree.
1. Names, addresses, and resident registration numbers of the Policyholder and the Insured
(Covered Person)
2. Contract details, e.g., date of contract conclusion, type of insurance, insurance premiums,
insurance coverage, etc.
3. Payment details, e.g., payment of insurance money and other benefits, reasons for
payment, etc.
4. Information on the injuries and/or diseases of the Insured (Covered Person)
Chapter 6. (Arbitration and Other Matters)
Article 32 (Arbitration)
In case of any and all disputes arising in relation to the insurance contract, the parties
concerned, interested parties, and Company may request for arbitration from the Financial
Supervisory Service.
Article 33 (Legal Jurisdiction)
Any lawsuit and civil arbitration in connection with this contract shall be instituted at the court
of the Republic of Korea that has jurisdiction over the area of the residence of the
Policyholder, If agreed upon the Company and the Policyholder, however, the legal
jurisdiction can be changed.
Article 34 (Interpretation)
¨ç The Company shall interpret the Provisions impartially based on the principle of trust and
good faith. Likewise, it shall not interpret the Provisions differently for each Policyholder.
¨è In case the meaning of any of the Provisions is unclear, the Company shall interpret them
in a manner that is more advantageous to the Policyholder.
¨é The Company shall not broadly interpret contents that are disadvantageous to the
Policyholder or the Insured (Covered Person), such as reasons for the non-payment of
insurance money.
Article 35 (Effects of the Insurance Guide Published by the Company)
In case the contents of the insurance guide (i.e., documents prepared to solicit subscriptions
to insurance) published by the Company and used by insurance solicitors selling insurance
policies vary from those of these Provisions, the insurance contract shall be considered to
have been concluded under provisions deemed more advantageous to the Policyholder.
Article 36 (Responsibility of the Company Related to the Indemnity for Loss)
¨ç The Company shall be liable to compensate for any damage occurred to the Policyholder,
the Insured (Covered Person), or the Beneficiary (Recipient of Insurance Money) for
reasons attributable to employees, insurance solicitors, and agents in accordance with
related laws, etc.
¨è The Company shall be liable to compensate for any loss incurred by the Policyholder, the
Insured (Covered Person), or the Beneficiary (Recipient of Insurance Money) if such loss
results from the filing of a lawsuit by the Company even though the Company had known
or could have known that there were no grounds for the refusal of or delay in insurance
money payment.
¨é Even if the Company has reached a apparently unfair agreement with the Policyholder, the
Insured (Covered Person), or the Beneficiary regarding whether the insurance payment is
paid or not as well as the amount of payment using his/her poverty, carelessness, or
inexperience, the Company still has the responsibility to compensate for the loss as per
Clause ¨è, Article 36 herein.
Article 37 (Adjudication of Bankruptcy of the Company and Termination)
¨ç The Policyholder may terminate the contract if the Company is declared bankrupt.
¨è A contract that has not been terminated in accordance with Clause ¨ç, Article 37 herein
shall lose its effect 3 months after the adjudication of bankruptcy.
¨é If the Contract has been terminated in accordance with Clause ¨ç, Article 37 herein, or it
has lost its effect in accordance with Clause ¨è Article 37 herein, the Company shall pay
the refund to the Policyholder according to Article 29 (Return of Insurance Premiums).
Article 38 (Payment Guarantee by the Deposit Insurance Fund)
In case the Company cannot pay insurance money due to bankruptcy or other reasons, the
payment of insurance money shall be guaranteed by the Depositors¡¯ Protection Law.
Article 39 (Governing Law)
Other matters that are not stipulated in these provisions shall be governed by the laws of the
Republic of Korea.
Special Provisions on the Indemnity for Disease-related Death
Article 1 (Kinds of Insurance Money and Reasons for Payment Thereof)
¨ç In case any of the following reasons for the payment of insurance money occurs on the
part of the Insured (Covered Person) during travel as set forth in Article 14 (Kinds of
Insurance Money and Reasons for Payment Thereof) of the General Provisions, the
Company shall pay the agreed upon insurance money to the Beneficiary of the insurance
(Recipient of the insurance money):
1. The Insured (Covered Person) dies of a disease during the insurance period: death
benefits
2. The Insured (Covered Person) has developed a disability as a disease definitely
diagnosed during the insurance period and for which the disability payment rate as
specified in the Disability Classification Table (see [Attachment 7]; the same shall apply
hereinafter) is 80% or over: sequela-related disability benefits
¨è Regardless of Clause ¨ç, Article _ herein, if the Insured (Covered Person) has died within
30 days from the end date of insurance period or has developed 80% or over disability as
a direct result of a disease occurred during travel, the company shall make compensation
equally.
Article 2 (Detailed Stipulations Concerning the Payment of Insurance Money)
¨ç Notwithstanding Item 1, Clause ¨ç , Article 1 (Kinds of Insurance Money and Reasons for
Payment Thereof), the Company shall recognize a temporary disability occurring for a
period of five (5) years or more after the injuries are completely healed even if the
symptoms are not permanent, by paying the insurance amount multiplied by 20% of the
relevant disability payment rate.
¨è If the disability payment rate in Item 2, Clause ¨ç , Article 1 (Kinds of Insurance Money and
Reasons for Payment Thereof) has not been decided until 180 days from the date of
definite diagnosis of a disease, the payment rate for the anticipated permanent physical
condition based on the doctor's diagnosis on the 180th day shall be applied. In case the
disability worsens during the period of coverage after the decision on the disability
payment rate (in case the contract has become ineffective, the period shall not exceed two
years from the date of definite diagnosis of a disease for a contract with insurance period
of 10 years or over and one year for a contract with insurance period of less than 10
years), however, the payment ratio based on the aggravated disability shall be applied. A
separately prescribed period, if any, for deciding the disability as shown in the Disability
Classification Table shall apply.
¨é The payment rate for sequela-related disability other than those shown in the Disability
Classification Table shall be decided based on the degree of disability classified in the
Disability Classification Table regardless of the occupation, age, social status, and gender
of the Insured (Covered Person). If the sequela-related disability does not qualify for the
minimum payment rate for the disability shown in the Disability Classification Table,
however, no Sequela-related Disability Benefits shall be given.
¨ê In case two (2) or more sequela-related disabilities develop from the same disease, the
payment rate of each disability shall be added and paid. Note, however, that separately
prescribed evaluation criteria for each body part as shown in the Disability Classification
Table shall apply, if any.
¨ë Notwithstanding the provisions of Clause ¨ê , Article 2 herein, in case two (2) or more
disabilities shown in the Disability Classification Table develop on the same part of the
body, the payment rate shall not be added; instead, the higher payment rate shall apply.
Note, however, that separately prescribed evaluation criteria for each body part as shown
in the Disability Classification Table shall apply, if any.
¨ì In case the Insured (Covered Person) and the Company fail to reach an agreement on the
disability payment rate for the Insured (Covered Person), they may designate a mutually
agreed upon third party and comply with the opinion of such third party. In this case, the
designated third party shall be one of the medical specialists belonging to a general
hospital as prescribed in Article 3 (Medical Institution) of the Medical Act, and the medical
expenses incurred in deciding the disability shall be paid in full by the Company.
Article 3 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Special Provisions of the Liability Policy
Article 1 (Indemnified Losses)
In case the Insured (Covered Person) inflicts bodily damages (i.e., injuries, diseases, death,
and sequela-related disability under these Special Provisions) or property damages (including
the disappearance, damage, or destruction of property) to the victim due to an insurance
accident (hereinafter referred to as the ¡°accident¡±) during the period of travel specified in
Article 14 (Kinds of Insurance Money and Reasons for Payment Thereof) of the General
Provisions and sustains damage as a result of fulfilling such legal liability, the Company shall
cover the expenses under these Special Provisions.
1. Compensation for damage that the Insured (Covered Person) is liable to pay to the victim
2. Necessary expenses incurred by the Policyholder or the Insured (Covered Person) as
follows:
A. Expenses incurred by the Insured (Covered Person), which is necessary or beneficial to
prevent or reduce loss in seeking ways of complying with Item 1 of Clause ¨ç , Article 11
(Duty to Prevent Loss).
B. Necessary or beneficial expenses incurred by the Insured (Covered Person) in seeking
ways of complying with Item 2 of Clause ¨ç , Article 11 (Du ty to Prevent Loss)
C. Expenses related to lawsuits, lawyer's fees, arbitration expenses, reconciliation or
mediation incurred by the Insured (Covered Person)
D. Deposit insurance guarantee within the limit of indemnity prescribed in the insurance
policy (insurance certificate). Note, however, that the Company shall not be liable to
provide such guarantee.
E. Expenses incurred by the Insured (Covered Person) in compliance with the requirement
of the Company as per Clauses ¨è and ¨é , Article 12 (Settlement of Claims by the
Company)
Article 2 (Non-indemnified Losses)
¨ç The Company shall not cover the damages sustained under any of the following cases:
1. As intended by the Policyholder or the Insured (Covered Person)
2. Earthquake, volcanic eruption, tidal wave or other similar act of God
3. War, use of armed forces by foreign countries, revolution, civil war, national incident, riot,
and other similar states
4. Radioactive, explosive, or other harmful accident involving nuclear fuel materials
(including used ones). This will remain the same hereinafter.) or materials contaminated
with nuclear fuel (including fission products).
5. Irradiation or radioactive contamination other than Item 4, Clause ¨ç , Article 2 herein
¨è The Company shall not cover the damages sustained as a result of fulfilling any of the
following:
1. Liability for the reparation of damage directly related to the performance of business by
the Insured (Covered Person)
2. Liability for the reparation of damage attributable to the movables owned, used, or
managed by the Insured (Covered Person) for business purposes only
3. Liability for the reparation of damage attributable to real estate owned, used, or managed
by the Insured (Covered Person)
4. Liability for the reparation of damage attributable to bodily injuries sustained in the
course of the performance of the duties of the employees of the Insured (Covered
Person) except household employees
5. Liability for the reparation of damage as determined by any agreement concluded
between the Insured (Covered Person) and other person regarding the compensation
for damage
6. Liability for the reparation of damage vis-a-vis the relatives sharing households with the
Insured (Covered Person) (relatives stipulated under Article 777 of the Civil Code) and
relatives accompanying the Insured (Covered Person) during travel
7. Liability for the reparation of damage to be extinctioned for a person with legal rights to the
property in case of damage to the property owned, used, or managed by the Insured (Covered
Person), excluding damage rendered to hotel guest rooms or to movables inside the guest
rooms
8. Liability for the reparation of damage attributable to a psychosomatic disorder of the
Insured (Covered Person)
9. Liability for the reparation of damage attributable to violence or assault at the instruction
of, the Insured (Covered Person)
10. Liability for the reparation of damage sustained attributable to owning, using, or
managing aircrafts, ships, vehicles (excluding manually operated vehicles), and/or
small arms (excluding air guns)
Article 3 (Relationship with Obligatory Insurance)
¨ç When the amount paid as per these provisions exceeds the amount paid by obligatory
insurance, the Company shall pay only the excess amount. In case there are multiple
obligatory insurances, however, payment is made according to Article 14 (Sharing of
Insurance Money).
¨è The obligatory insurance in Clause ¨ç , Article 3 herein is the insurance to be subscribed by
the Insured (Covered Person) by law; it includes fraternal insurance contract (insurance
contracts concluded with fraternal insurance associations).
¨é In case the Insured (Covered Person) has not subscribed to obligatory insurance, even though
he/she was obliged to subscribe to it, the Company shall regard the amount estimated to be paid
by the obligatory insurance in case he/she had subscribed to it as "the amount to be paid by the
obligatory insurance" in Clause ¨ç , Article 3 herein .
Article 4 (Upper Limit of Payment of Insurance Money)
¨ç The Company shall pay for 1 insurance accident as follows. In this case, the insurance
money (upper limit of insurance payment) and deductible shall mean each of the amount
prescribed in the insurance policy (insurance certificate):
1. Compensation for damage as per Item1 of Article 1 (Indemnified Losses):
Compensation shall be made up to the insurance money (upper limit of insurance
payment). In case of any deductible, the Company shall only pay the amount that
exceeds such deductible.
2. Expenses as per 'A', 'B' or 'E' as per Item2 of Article 1 (Indemnified Losses): the
Company shall pay the agreed upon insurance money.
3. Expenses as per 'C' or 'D' as per Item2 of Article 1 (Indemnified Losses): the Company
shall pay the sum of this expense and the compensation amount as per Item 1, Clause
¨ç, Article 4 herein, up to insurance money (upper limit of insurance payment).
¨è In case the Company already paid pursuant to Clause ¨ç, Article 4 herein, the balance after the
amount already paid is deducted from the Insurance money (upper limit of insurance
payment) should be a new Insurance money (upper limit of insurance payment) for the rest
of the insurance period.
Article 5 (Duty to Disclose Prior to Contract Conclusion)
The Policyholder, the Insured, or their representative should provide true and correct
information to the best of their knowledge when filling out the application form (including
questionnaire) at the time of application.
Article 6 (Duty to Disclose After Contract Conclusion)
¨ç In case any of the following occurs with regard to the purpose of insurance after contract
conclusion, the Policyholder or the Insured should notify the Company in writing without
delay and obtain verification on the insurance policy (insurance certificate):
1. In case the Policyholder or the Insured wishes to change the written content of the
application or he/she recognizes that there is a change
2. In case the Policyholder or the Insured wishes to subscribe an insurance that offers the
same coverage as the coverage of this contract from another insurance provider, or
recognizes that there is such an insurance
3. In case the risk was apparently changed, or the Policyholder or the Insured recognizes
the change of the risk
¨è In case the risk is reduced according to Clause ¨ç, Article 6 herein, the Company shall
return the difference in the insurance premium. In case the risk increases, the Company
may request for an increase in the insurance premium or terminate the contract within 1
month of the reception of the notification.
¨é The Policyholder should notify the Company without delay when his/her address or contact
information is changed. If the Policyholder fails to notify the Company of such change, a
notice sent by registered mail by the Company to the address and/or contact details last
known to the Company shall be construed to have reached the Policyholder after the time
that is generally required for arrival has lapsed.
Article 7 (Termination of the Contract)
¨ç The Policyholder may terminate the contract anytime before the occurrence of loss. In
case of a contract for another person, however, the Policyholder may terminate the
contract provided he/she obtains consent from the person or has the insurance policy
(insurance certificate).
¨è The Company may terminate the contract if the Policyholder, or the Insured (in case of a
corporation, its director or other institution that executes the business of the corporation)
intentionally causes reasons for loss to occur.
Under any of the following cases, the Company may terminate this Contract within 1 month
of recognizing the facts regardless of the occurrence of losses:
1. Notwithstanding Article 5 (Duty to Disclose Prior to Contract Conclusion) herein, the
Policyholder, the Insured (Covered Person), or their representative fails to notify the
Company of an important matter intentionally or due to gross negligence
2. In case the duty to disclose after contract conclusion as specified in Article 6 (Duty to
Disclose After Accident Insurance Contract Conclusion) and in relation to the apparent
increase in risks has not been fulfilled
Notwithstanding the provisions of Item 3, Clause ¨ç , Article 7 herein, the Company shall
not terminate this Contract under any of the following cases
1. The Company has known the fact at the time of conclusion of the contract or has not
known the fact due to negligence.
2. More than 1 month has passed since the Company has recognized the fact
3. Three years have passed from the date of conclusion of the contract.
4. The insurance salesman (hereinafter referred to as "insurance agent and etc.") has not
given the Policyholder or the Insured the opportunity to notify or have interrupted the
notification of the truth. The insurance agent, etc., have had the Policyholder or the
Insured withhold information or have falsified the notice. In case the Policyholder or the
Insured is recognized to have withheld information or to have falsified the notice
regardless of the insurance agent and another person¡¯s action, however, this does not
apply.
¨ë The Company shall not cover the losses when the contract was terminated as per Clause
¨é , Article 7 herein, even after loss had been incurred. Note, however, that the Company
shall pay insurance money, if the Policyholder or the Insured proves that the facts as per
Items 1 and 2, Clause ¨é , Article 7 herein have not affected the occurrence of the loss.
¨ì The Company shall neither terminate the Contract nor refuse the payment of insurance
money on the grounds of violation of the Duty to Disclose for another insurance policy.
Article 8 (Contract on Behalf of Other Persons)
¨ç In case a Policyholder concludes a contract for another person, and in the absence of an
authorization from the other person, the Policyholder shall notify the Company accordingly.
If the Policyholder neglected notification, however, the said other person cannot raise
complaints against the Company on the ground that he/she was not aware of the
existence of the contract.
¨è In case of an insurance-covered accident in relation to the contract for another person, and
if the Policyholder paid the other person for the damage resulting from such accident, the
Policyholder may request the Company to pay insurance money within a range that does
not infringe the rights of the other person.
Article 9 (Nullification of the Contract)
The contract shall be void in case the insurance accident has already occurred prior to the
conclusion of the contract. If the termination is attributable to the negligence or fault of the
Company, or the Company has recognized -- or could have known ? that the Contract is not
valid but has not returned the insurance premium, the Company shall return the insurance
premium received plus interest at the rate announced by the Korea Insurance Development
Institute compounded annually and applied to the fixed deposit for the period starting from the
next day of the date the premium was supposed to be returned to the date the premium was
actually returned.
Article 10 (Notification of Loss)
¨ç In case of an accident, the Policyholder or the Insured (Covered Person) shall immediately
report the following details in writing to the Company:
1. Time and place of accident, address and names of victims, accident details, and address
and names of witnesses, if any
2. Claims filed by the victim
3. Lawsuit filed by the victim regarding the liability for reparation for damage
¨è In case the damages are aggravated because the Policyholder or the Insured (Covered
Person) fails to notify the Company pursuant to Clause ¨ç, Article 10 herein, the Company
shall not cover the additional portion. Similarly, if the Policyholder or the Insured (Covered
Person) fails to notify the Company as per Item 3 of Clause ¨ç, Article 10 herein, the
Company shall not cover the cost of lawsuits and the lawyer¡¯s fee.
Article 11 (Duty to Prevent Loss)
¨ç In case of an insurance-covered accident, the Policyholder or the Insured (Covered
Person) shall have the following obligations:
1. Make efforts to prevent or minimize damage (including first aid treatment to the victim,
ambulance service, and other emergency measures).
2. Take appropriate measures to protect or exercise rights in case the indemnification for
damage by the 3rd party is possible.
3. Obtain prior consent from the Company in case the Policyholder or the Insured (Covered
Person) wishes to pay (repay), approve, or reconcile, file a lawsuit, or apply for
arbitration or mediation regarding the part or the whole liability
4. Obtain prior consent from the Company in case the Insured (Covered Person) wishes to
file a lawsuit regarding the liability for reparation.
¨è In case the Policyholder or the Insured (Covered Person) fails to fulfill the duty stipulated in
Clause ¨ç, Article 11, herein without justifiable reasons, the following amount shall be
deducted from the loss as per Article 1 (Scope of Losses):
1. In case of Item 1, Clause ¨ç, Article 11 herein, the amount corresponding to the loss that
could have been prevented or reduced had efforts been made
2. In case of Item 2, Clause ¨ç, Article 11 herein, the amount corresponding to the loss that
could have been compensated for by a third party
3. In case of Item 3, Clause ¨ç, Article 11 herein, the loss that has been increased by the
cost of lawsuits (including arbitration or mediation), lawyer¡¯s fees, and actions that are
not agreed to by the Company
Article 12 (Settlement of Claims by the Company)
¨ç In case of an accident wherein the Insured (Covered Person) is liable to indemnify the
victim for damages sustained, the victim may directly request the Company to pay
insurance money within the range of liability of the Company to pay insurance money to
the Insured (Covered Person) under these Special Provisions. In this case, however, the
Company may contest such claim by invoking the right to defend held by the Insured
(Covered Person) for such accident.
¨è Upon the receipt of claims in accordance with the provisions of Clause ¨ç, the Company
shall immediately notify the Insured (Covered Person) accordingly. The Policyholder or the
Insured (Covered Person) shall extend his/her cooperation by submitting the required
documents, testifying, or attending as a witness as requested by the Company.
¨é In case the victim files a claim against the Insured (Covered Person), the Company may
settle the case and shoulder the corresponding expenses on behalf of the Insured
(Covered Person) as necessary. In this case, the Policyholder or the Insured (Covered
Person) shall provide the necessary cooperation as requested by the Company.
¨ê In case the Policyholder and the Insured (Covered Person) fail to extend their cooperation
regarding the requests made by the Company as stipulated in Clauses ¨è and ¨é, Article
12 herein without justifiable reasons, the Company shall not cover the additional damage
resulting from such negligence.
Article 13 (Payment of Insurance Money)
¨ç When requesting for the payment of insurance money, the Insured (Covered Person) shall
submit the following documents:
1. Application for insurance money
2. Identification cards (identification cards issued by the Government, e.g., resident
registration card or driver¡¯s license with photo attached, including certificates of official
seal impression in case the Policyholder is not the Beneficiary himself/herself)
3. Certificates providing the payment of the amount of claims and other expenses
4. Other documents required by the Company
¨è Upon receiving the application for insurance money pursuant to Clause ¨ç , Article 13
herein, the Company shall immediately determine the insurance amount to be paid and
issue the corresponding payment within ten (10) business days of deciding the amount. If
an investigation conducted in relation to the payment of insurance money cannot be
completed within such period, and in case of a request from the Insured (Covered Person),
however, the Company shall pay provisional insurance money equivalent to 50% of the
insurance money as estimated by the Company.
¨é If it fails to pay insurance money ten (10) business days after the amount of insurance
money is decided pursuant to Clause ¨è , Article 13 herein, the Company shall pay an
interest calculated by applying the interest rate applicable to the 1-year maturity fixed
deposit as announced by the Korea Insurance Development Institute compounded
annually to cover the period starting from the first day of delay to the day of payment in
addition to the insurance money. If payment is delayed for reasons attributable to the
Insured (Covered Person), however, no interest shall be paid for the relevant period.
¡¼Definition¡½
¡®Business days¡¯ pertains to ordinary days excluding ¡°Saturdays,¡± ¡°Sundays,¡± ¡°legal holidays
set by the government,¡± and ¡°Labor Day.¡±
Article 14 (Sharing of Insurance Money)
¨ç In case of other contracts (including fraternal insurance contract [insurance contracts
concluded with fraternal insurance associations]) covering the same risks covered by this
contract, and if the total amount of liability calculated under the assumption that there are
no other contracts exceeds the covered damage, the Company shall pay insurance money
according to the ratio of liability under these Special Provisions vis-a-vis the
abovementioned total amount (total liability for reparation calculated). The same rule shall
apply even if all contracts other than this contract are obligatory insurance.
¨è In case the contracts are not obligatory insurance, and there is another obligatory insurance, the
Company shall consider an amount from which the amount covered by the other obligatory
insurance (amount estimated to be paid in case the Insured (Covered Person) has not
subscribed to such insurance) is deducted as the amount of damage and determine the amount
to be paid pursuant to Clause ¨ç, Article 14 herein.
¨é The Company shall determine the amount of insurance money to be paid pursuant to
Clause ¨ç, Article 14 herein even if the Insured (Covered Person) has waived his/her
claims for insurance money vis-a-vis other contracts
Article 15 (Subrogation Rights)
¨ç Once it pays insurance money (including the case of payment in kind), the Company shall
carry the following rights within the scope of the insurance money paid (in case the
amount paid by the Company is part of the damage sustained by the Insured (Covered
Person), however, the Company shall have rights within a range that does not infringe the
rights of the Insured (Covered Person)):
1. Relevant claim rights in case the Insured (Covered Person) can obtain compensation for
damage from the 3rd party
2. Relevant subrogation rights in case of certain rights that can be acquired by the Insured
(Covered Person) in subrogation by compensating for the damage
¨è The Policyholder or the Insured (Covered Person) shall take the necessary measures
related to the protection or exercise of the rights acquired by the Company pursuant to
Clause ¨ç, Article 15 herein and submit evidence and documents as requested by the
Company.
¨é Notwithstanding the provisions of Clauses ¨ç and¨è, Article 15 herein, the Company shall
waive the subrogation rights of the Policyholder once the contract is concluded for other
persons.
Article 16 (Agreement, Compromise, Arbitration, Cooperation, or Acting as Proxy for a
Lawsuit)
¨ç To settle the liability of the Insured, the Company may cooperate on an agreement, a
compromise, an arbitration, or a lawsuit (including Feststellungsklage) executed by the
Insured with the victim or may act as proxy for the Insured.
¨è The Company shall cooperate on or act as proxy for the Insured for the procedure in
accordance with Clause ¨ç, Article 16 herein within the limit of the liability (If there's any
insurance money paid or provisional insurance money for the same accident, that amount
shall be deducted. And the same shall be applied for the followings).
¨é In case the Company cooperates on or acts as proxy for the procedure in Clause ¨ç,
Article 16 herein, the Insured (Covered Person) shall cooperate at the request of the
Company. In case the Insured (Covered Person) does not cooperate without justifiable
reason, the Company shall not compensate for the loss that has been increased due to
such non-cooperation.
¨ê The Company shall not act as proxy for the procedure as per Clause ¨ç, Article 16 herein
under any of the following cases:
1. The amount of liability to be paid by the Insured to the victim distinctively exceeds the
face amount indicated in the insurance policy (insurance certificate)
2. The Insured does not cooperate without justifiable reason.
¨ë When acting as proxy for the procedure in Clause ¨ç, Article 16 herein, the Company may
lend the deposit to avoid provisional seizure or provisional execution on the part of the
Insured within the limit of the liability and shall compensate for the cost. In this case, the
interest for the loan shall be the same rate as that of the deposit, and the Insured shall
transfer the rights to claim the collection of the deposit (including its interest) to the
Company.
Article 17 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Special Provisions on the Indemnification of Loss
of Personal Effects
Article 1 (Identification of Insured Objects)
¨ç Insured objects are limited to the personal effects owned, used, and managed by the
Insured (Covered Person) during travel.
¨è The following items are excluded:
1. Currencies, securities, revenue stamps, postal stamps, credit cards, coupons, air tickets,
passports, and other similar items
2. Manuscripts, design documents, designs, original objects, models, certificates, books,
molds (metal) and wooden frames (wood), and software and other similar items
3. Ships or vehicles (including 3-wheel and 2-wheel motor cars)
4. Articles required for mountain climbing or expedition
5. Animals and plants
6. Dentures, artificial legs, and contact lenses
7. Other items (those specified in the insurance policy (insurance certificate))
Article 2 (Indemnified Losses)
In case the Insured (Covered Person) causes damage to the insured object due to a sudden,
unexpected accident occurring during travel as stipulated in Article 14 (Kinds of Insurance
Money and Reasons for Payment Thereof) of the General Provisions, the Company shall
indemnify the Insured (Covered Person) accordingly under these Special Provisions.
Article 3 (Non-indemnified Losses)
¨ç The Company shall not pay insurance money in case any reason for insurance money
payment occurs under any of the following cases:
1. Earthquake, volcanic eruption, sunami, or other similar act of God
2. War, use of armed forces by foreign countries, revolution, civil war, national incident,
terrorism, riot, and other similar states
3. Radioactive, explosive, or other harmful accident involving nuclear fuel materials
(including used ones). This will remain the same hereinafter.) or materials contaminated
with nuclear fuel (including fission products).
4. Irradiation or radioactive contamination other than Item 3, Clause ¨ç , Article 2 herein
¨è The Company shall not cover the damages sustained under any of the following cases:
1. Intentional or serious negligence by the Policyholder or the Insured (Covered Person)
2. Damages intentionally caused by relatives or employees accompanying the Insured
(Covered Person) during travel to enable the payment of the insurance money to the
Insured (Covered Person)
3. Exercise of public power by the government or public institutions including attachment,
requisition, seizure, and/or destruction, except in cases wherein such action is required
to avoid or fight fires or to take shelter
4. Damage caused by the defects of the insured object; note, however, that the Company
shall cover the damages caused by defects that are not discovered despite the due care
exercised by the Policyholder, the Insured (Covered Person), or persons managing the
insured object on behalf of the Policyholder or the Insured (Covered Person).
5. Spontaneous consumption, rust, mildew, deterioration, and discoloration of the insured
objects and damage caused by rats or insects
6. Simple external damage that does not affect the functions
7. Spillage in case the insured object is in liquid form; Company shall cover the damage
rendered to the other insured objects as a result of such spillage
8. Leaving the insured object unattended or losing it
Article 4 (Duty to Prevent Loss)
¨ç In case of an insurance-covered accident, the Policyholder or the Insured (Covered
Person) shall exert effort to prevent or minimize the resulting damages. In case the
Policyholder or the Insured (Covered Person) neglects such duty intentionally or by gross
negligence, the Company shall deduct the amount equivalent to the damage that could
have been prevented or minimized.
¨è The Company shall indemnify for the expenses (hereinafter referred to as the "Loss
Preventive Expenses") spent as necessary to or to help prevent or lessen the loss
described in Clause ¨ç , Article 4 based on the insurance calculation method stipulated in
Article 6 (Calculation of Insurance Money Payment).
¨é Even if the total amount exceeds the insured amount, the Company shall pay the
insurance money specified in Article 6 (Calculation of Insurance Money Payment) together
with the amount equivalent to the expenses incurred to prevent the damage specified in
Clause ¨è , Article 4 herein
Article 5 (Inspection and Determination of the Amount of Loss)
The amount of damage to be covered by the Company shall be calculated based on the
prevailing value of the insured object (hereinafter referred to as the "Insurable Value") at the
time and place where such damage occurred.
Article 6 (Calculation of Insurance Money Payment)
¨ç The insurance money to be paid by the Company shall be equivalent to the amount
derived by deducting the self-payment entered in the insurance policy (insurance
certificate) for every accident from the amount of damage.
¨è In case the damage to the insured object is repaired, the expenses incurred to restore the
insured object to its original condition shall be regarded as the damage specified in Clause
¨ç , Article 6 herein.
¨é In case the insured object is composed of sets or pairs, and if part of such sets or pairs is
damaged, the Company shall calculate the amount of damage considering the influences
of such damage on the total value of the insured object. In this case, under no
circumstances shall the damage be regarded as total loss except in cases wherein the
relevant repair expenses exceed the insurable value.
¨ê The insurance money to be paid pursuant to Clause ¨ç , Article 6 herein for each insured
object or one (1) set or one (1) pair of such shall be limited to KRW 200,000.
¨ë In case of other contracts covering the same risks covered by this contract involving the
insured object, and if the total amount of liability calculated under the assumption that
there are no other contracts exceeds the covered damage, the Company shall pay
insurance money according to the ratio of liability under these Special Provisions vis-a-vis
the abovementioned total amount of liability.
Article 7 (Treatment of Residual and Stolen Articles)
¨ç Once the Company pays insurance money, the remaining part of the insured object shall
be reverted to the Insured (Covered Person) unless the Company expresses its intention
to acquire such part.
¨è In case the stolen insured object is discovered, the following action shall be taken:
1. An insured object that is recovered before the Company pays insurance money shall be
regarded as if it had not been stolen.
2. If the insured object is recovered after the Company pays insurance money, the
ownership of the object shall be reverted to the Company. In this case, the Company
shall sell the object in question at an appropriate price. If the price exceeds the sum of
the amount paid for the insured object and expenses incurred for the recovery or sale of
the item, the Company shall return the excess amount to the Insured (Covered Person).
Note, however, that the Insured (Covered Person) may recover the insured object in
question after returning to the Company the insurance money received prior to its sale.
¨é In case of damages due to causes other than the theft or robbery of the insured object as
per Clause ¨è , Article 7 herein and expenses incurred by the Policyholder or the Insured
(Covered Person) to recover such insured object, the Company shall pay insurance
money equivalent to the amount calculated based on the calculation method stipulated in
Article 6 (Calculation of Insurance Money Payment).
Article 8 (Subrogation Rights)
¨ç Once it pays insurance money (including the case wherein payment is made in kind), the
Company shall acquire the claim for damage held by the Policyholder or the Insured
(Covered Person) against the 3rd party within the scope of the insurance money paid. In
case the amount paid by the Company is part of the damage sustained by the Insured
(Covered Person), however, the Company shall acquire the rights within a range that does
not infringe the rights of the Insured (Covered Person).
¨è The Policyholder or the Insured (Covered Person) shall take the necessary measures
related to the protection or exercise of the rights acquired by the Company as per Clause
¨ç, Article 8 herein and submit evidence and documents as requested by the Company,
¨é Notwithstanding the provisions of Clauses ¨ç and ¨è, Article 8 herein, the Company shall
waive the subrogation rights of the Policyholder once the contract is concluded for other
persons.
Article 9 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Special Provisions on the Indemnity for Special Expenses
Article 1 (Indemnified Losses)
¨ç The Company shall pay insurance money pursuant to these Special Provisions to cover
the expenses incurred by the Policyholder or the Insured (Covered Person) or his/her legal
successor under any of the following cases:
1. An airplane or a ship whose passengers include the Insured (Covered Person) is
involved in an accident, he/she is declared missing during travel (hereinafter referred to
as "During Travel") as specified in Article 14 (Kinds of Insurance Money and Reasons
for Payment Thereof) of the General Provisions, or the Insured (Covered Person) is
involved in an accident during a mountain climbing activity.
2. The Insured (Covered Person) is involved in a sudden, unexpected accident during travel,
requiring emergency search and rescue operations as certified by public institutions
such as the police.
3. The Insured (Covered Person) sustains bodily injuries due to accidents specified in Article
14 (Kinds of Insurance Money and Reasons for Payment Thereof) of the General
Provisions and dies within one (1) year of the date of accident, or he/she is hospitalized
continuously for a period of fourteen (14) days or longer as a direct result (if the Insured
(Covered Person) is transferred to another medical institution, the period required for the
transfer shall be regarded as the hospitalization period only when the doctor sees the need
for such; the same shall apply hereinafter).
4. The Insured (Covered Person) dies during travel due to diseases, and he/she is
hospitalized continuously for a period of fourteen (14) days or longer as a direct result of
the diseases acquired during travel and as necessary due to diseases whose medical
treatment has been started during travel.
¨è In case the fate of the Insured (Covered Person) is uncertain during a mountain climbing
activity as specified in Item 1, Clause ¨ç , Article 1 herein, an acci dent shall be assumed to
have occurred when the Policyholder or legal successors of the Insured (Covered Person)
or their representatives request the police, rescue squad, marine disaster rescue
companies, airlines, or other public institutions to conduct a search after the expected time
for the Insured (Covered Person) to return has passed
Article 2 (Scope of Expenses)
¨ç Below are the range of expenses to be paid by the Company:
1. Search and rescue expenses
These refer to expenses out of those required in searching for, rescuing, or transporting
(hereinafter referred to as the "Search") the Insured (Covered Person) in distress as paid for by
the Insured (Covered Person) at the request of the persons who have participated in such
activities.
2. Transportation expenses including airfare
Transportation expenses including airfare refer to the round-trip fare required to proceed
to the scene of the accident to search for or nurse the Insured (Covered Person) or
handle an accident or local round-trip fare required by the legal successors of the
Insured (Covered Person) (including legal representatives; hereinafter referred to as the
"Salvers¡±) These expenses shall be paid for two (2) persons only.
3. Lodging expenses
Lodging expenses shall include those required by the salvers on-site. Expenses shall be paid
for two (2) persons only for a maximum of fourteen (14) days per person.
4. Transportation expenses
Transportation expenses refer to the expenses required to transport the remains from the
site to the address of the Insured (Covered Person) as entered in the insurance policy
(insurance certificate) in case of the death of the Insured (Covered Person) and/or the
expenses required to transport the Insured (Covered Person) under continuous
treatment from the site to the address entered in the insurance policy (insurance
certificate) beyond the normal amount of transportation expenses for the Insured
(Covered Person) and escorting expenses of the accompanying doctors and/or nurses.
5. Miscellaneous expenses
Miscellaneous expenses shall include those related to the immigration procedure (passport
revenue stamp fee, visa fees, and/or preventive vaccination fees) incurred by salvers and
transportation expenses, communication expenses, and necessary expenses for disposing of
the remains of the Insured (Covered Person) as paid for by the salvers or the Insured
(Covered Person) on-site, provided that the total amount does not exceed KRW 100,000.
Article 3 (Non-indemnified Losses)
Notwithstanding the provisions of Article 16 (Reasons for Non-Payment of Insurance Money)
of the General Provisions, the Company shall not pay insurance money for damage due to
any of the causes specified in Items 1~3,5, Clause ¨ç of the same article
Article 4 (Payment of Insurance Money)
The Company shall cover only the portion deemed justifiable out of the expenses listed in
Article 2 (Scope of Expenses); note, however, that the Company shall not pay insurance
money if the Policyholder or the Insured (Covered Person) or the Beneficiary can receive
compensation for damage from other persons.
Article 5 (Sharing of Insurance Money)
In case of other contracts covering the expenses as specified in Article 1 (Indemnified
Losses), and if the total amount of liability calculated under the assumption that there are no
other contracts exceeds the expenses, the Company shall pay insurance money according to
the ratio of liability under this contract vis-a-vis the abovementioned total amount.
Article 6 (Indemnity Limit)
The insurance money to be paid by the Company as per these Special Provisions shall be
limited to the amount covered under these Special Provisions throughout the insurance
period.
Article 7 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Special Provisions on the Indemnity for Airplane Hijacking
Article 1 (Indemnified Losses)
¨ç The Company shall pay KRW 70,000 for each day of delay of the arrival by the Insured
(Covered Person) at his/her destination due to the hijacking of the airplane (hereinafter
referred to as the ¡°Accident¡±) where the Insured (Covered Person) is a passenger while
traveling as described in Article 14 (Kinds of Insurance Money and Reasons for Payment
Thereof) of the General Provisions.
¨è The hijacking of the airplane as described in Clause ¨ç , Article 1 herein shall refer to the
seizure or exercise of control of the airplane using violence, physical assault, or threat of
violence or physical assault for unlawful purposes.
Article 2 (Scope of Indemnified Loss)
¨ç The Company shall pay the insurance money specified in Article 1 (Indemnified Losses) for
up to 20 days assuming 1 day has 24 hours starting from 12 hours after the estimated time
of arrival of the airplane at the destination.
¨è If the departure of the airplane had also been delayed before the accident is first
discovered, the days shall be counted assuming 1 day has 24 hours starting from 12 hours
as described in Clause ¨ç , Article 2 herein, plus such period of delay.
Article 3 (Relationship with Other Insurance)
In case a number of other insurance contracts similar to this provision are simultaneously in
effect, indemnity shall be provided in accordance with only one insurance contract selected
by the Insured (Covered Person), the Beneficiary, or his/her legal successor, and the
Company shall return the relevant premium already paid for other contracts.
Article 4 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Special Provisions on Group Contracts
Article 1 (Application Scope)
These Special Provisions apply to the contract (hereinafter referred to as the "Group
Contract") that satisfies the following conditions when General Provisions (including Special
Provisions if attached; the same shall apply hereinafter) is agreed upon:
1. The Insured (Covered Person) may be the members of one of the following organizations
(the person designated as the Policyholder representing the group shall be able to
exercise and fulfill all rights and obligations arising from the group insurance contract):
A. Class 1 group (salary-related groups)
includes government offices, state-run corporations, corporations, plants, and other
groups paying specific salaries to their members.
B. Class 2 group (legal groups)
includes corporations, associations and similar organizations that are not classified as
class 1 groups and established as per the Civil Code or special laws.
C. Class 3 group (regulated groups)
includes organizations not belonging to the class 1 and class 2 groups but having major
items on the organization operation as fixed by regulations or Articles of Incorporation,
excluding groups organized merely to subscribe to the insurance.
2. The representatives of the organizations as specified in Clause ¨ç , Article 1 herein shall
be named Policyholders, and the number of the Insured (Covered Person) of the
organizations shall be at least five (5).
Article 2 (Amount of Insurance Subscription)
¨ç In principle, the insured amount of the Insured (Covered Person) shall be allotted equally.
¨è For class 1 group, the insured amount for each of the Insured (Covered Person) belonging
to the same job title or position grade shall be the same even if the Policyholder wishes to
establish different individual policy amounts. In case it is difficult to apply the job title or
position grade of the Insured (Covered Person), however, the insured amount may be
established differentially
Article 3 (Increase and Decrease in the Number and Replacement of the Insured (Covered Person))
¨ç If it wishes to increase or decrease the number of, or replace the Insured (Covered
Person) accordingly after concluding the group contract, the Policyholder or the Insured
(Covered Person) shall immediately notify the Company accordingly for approval.
¨è In case the number of the Insured (Covered Person) decreases during the insurance
period, the contract covering the Insured (Covered Person) shall be considered canceled.
The insurance period for the additional number or replacement of the Insured (Covered
Person) shall be regarded as the time left of the insurance period in this contract, with the
resulting additional or return premiums calculated on a per diem basis and collected or
returned accordingly.
¨é The Company shall not pay insurance money to the additional number or replacement of
the Insured (Covered Person) in case the provisions of Clauses ¨ç and ¨è , Article 3 herein
are violated.
Article 4 (Return of Insurance Premiums)
Notwithstanding the provisions of Article 29 (Refund of Insurance Premium) of the general
provisions, an amount shall be deducted from the premiums calculated based on the short-
term rate covering the period that already lapsed, in case the contract is terminated for
reasons attributable to the Policyholder. Note, however, that the premiums shall not be
returned if the insurance premium covering the period that already lapsed and calculated as
above is less than the insurance money paid.
Article 5 (Special Rule of Application)
The Company shall deliver the insurance policy (insurance certificate) to the Policyholder only.
Article 6 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Additional Special Provisions of the Blanket Policy
Article 1 (Application Scope)
These Special Provisions apply to contracts under which the overseas travel of the Insured
(Covered Person) as disclosed by the Policyholder during the specified contract term
designated as the insurance period is comprehensively covered by the Company as per the
conditions specified in Article 3 (Notification of Overseas Travelers) hereof.
¡ØPolicyholder:
¨ç General travel agencies and overseas travel agencies registered in accordance with the
provisions of the Tourism Promotion Act and its Enforcement Decree
¨è Representatives of Class 1, Class 2, and Class 3 groups specified in Item 1, Article 1
(Application Scope) of the Special Provisions on Group Contracts
¡ØThe Insured (Covered Person)
¨ç Overseas travelers arranged and/or sponsored by travel agencies
¨è Overseas travelers, belonging to Class 1, Class 2, and Class 3 groups
Article 2 (Insurance Premiums)
¨ç The Policyholder shall submit to the Company a report on the expected number of overseas
travelers and insurance conditions for the insurance period before concluding the contract and
pay the estimated insurance premiums calculated according to such conditions.
¨è The Company shall calculate the actual insurance premiums based on the details reported in
accordance with Article 3 (Notification of Overseas Travelers) hereof and collect or return the
difference of the estimated insurance premiums specified in Clause ¨ç above within seven (7)
days of the expiration of the insurance period.
Article 3 (Notification of Overseas Travelers)
The Policyholder or its representative shall submit a written notice (including notice through
Fax) containing information on the Insured (Covered Person) as shown on [Attachment]. The
liability of the Company shall begin the moment it receives the notice specified on
[Attachment]. In case such notice is delayed when sent via snail mail, three (3) days after the
date of the post office stamp will be considered as the date the notice was received by the
Company
Article 4 (Application of the Provisions)
Other matters that are not stipulated in these Additional Special Provisions shall be governed
by the General Provisions and the Special Provisions on Group Contracts.
Additional Special Provisions on the Settlement of Premiums
[Group Contract]
Article 1 (Settlement of Premiums)
¨ç Notwithstanding the provisions of Clause ¨è, Article 3 (Increase and Decrease in the
Number and Replacement of the Insured (Covered Person)) of the Special Provisions on
Group Contracts (hereinafter referred to as "Special Provisions"), the Company shall settle
insurance premiums in accordance with the provisions of these additional Special
Provisions.
¨è Notwithstanding the provisions of Clause ¨é, Article 3 (Increase and Decrease in the
Number and Replacement of the Insured (Covered Person)) of the Special Provisions, the
Company shall indemnify the additional number or replacement of the Insured (Covered
Person) for any damage sustained even before the insurance premiums are settled.
Article 2 (Amount of Insurance Subscription)
Notwithstanding the provisions of Article 2 (Amount of Insurance Subscription) of the Special
Provisions, the Company may allow the Policyholder to establish a different policy amount for
each insured for class 2 and class 3 groups considering the contract details.
Article 3 (List of the Insured (Covered Person))
The Policyholder shall always maintain a list of the Insured (Covered Person) for submission
to the Company as may be requested for inspection purposes.
Article 4 (Premium Deposit)
The insurance premium deposit shall be calculated by applying the insurance rates derived
based on the daily average number of personnel for one (1) month prior to contract
conclusion.
Article 5 (Method of Settlement of Premiums)
Depending on the increase/decrease in the number of the Insured (Covered Person),
insurance premiums shall be settled as follows:
1. The Policyholder shall submit to the Company a report on the number of the Insured
(Covered Person) as of the end of the previous month by the 10 th of each month. In
case the insurance contract is rendered invalid or canceled, however, the Policyholder
shall submit the necessary documents for calculating the insurance premiums shortly up
to the day the contract is rendered invalid or canceled
2. The Company may inspect the documents of the Policyholder as necessary to calculate
the insurance premiums during or after the insurance period.
3. Upon the expiration of the insurance period, the Company shall compare the fixed
insurance premiums calculated based on the number of the Insured (Covered Person)
against the deposit insurance premiums calculated at the time of contract conclusion
and settle the difference.
Article 6 (Application of the Provisions)
Other matters that are not stipulated in these Additional Special Provisions shall be governed
by the General Provisions and the Special Provisions on Group Contracts.
Special Provisions on the Indemnity for Married Couples
Article 1 (Scope of the Insured (Covered Person))
The Company hereby adopts the definition of the Insured (Covered Person) as used in the
General Provisions and the relevant Special Provisions attached thereto as being the Insured
(Covered Person) and his or her spouse as indicated in the insurance policy (insurance
certificate) in accordance with these Special Provisions.
Article 2 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions and the relevant Special Provisions as attached.
Special Provisions of the Family Subscription
Article 1 (Scope of the Insured (Covered Person))
¨ç The Company shall consider the principally insured (hereinafter referred to as the
¡°Principally Insured") and the following family members as entered in the insurance policy
(insurance certificate) pursuant to these Special Provisions as the Insured (Covered
Person) in the General Provisions (including the Special Provisions).
1. Spouse of the principally insured
2. Parents of the principally insured and the spouse
3. Unmarried children of the principally insured and the spouse
¨è The relationship Principally Insured and other family members in Clause ¨ç above refers to
the relationship at the time of the accident.
Article 2 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions.
¡¼Definition¡½
¢Á The definition of spouse, parents, and children as set forth in the Special Provisions on
the Indemnity for Married Couples and Special Provisions of the Family Subscription is as
follows:
1. Spouse of the principally insured means the legal or common-law spouse.
2. Parents of the principally insured and the spouse include step parents.
3. Children of the principally insured and the spouse pertains to the children born from
legal marriage or common-law marriage, stepson or stepdaughter.
Special Provisions on the Payment of Insurance Premiums Using
Credit Cards
Article 1 (Application Scope)
These Special Provisions shall apply to cases wherein the Policyholder pays insurance
premiums using a credit card as a credit card member of credit card companies (hereinafter
referred to as Credit Card Companies) or pays insurance premiums automatically through the
credit card agency as a credit card member of Credit Card Companies.
Article 2 (Receipt of Insurance Premiums)
The Company shall regard the time the Policyholder provides the necessary information for
him/her to pay insurance premiums through the designated credit card in accordance with
these special provisions as the time of receipt of the insurance premiums. In case approval is
not possible for reasons attributable to the Policyholder, however, the Company shall regard
the date the credit card company actually approves such payment as the time of receipt of
insurance premiums.
Article 3 (Contract Based on Fraudulent Cards)
¨ç An insurance contract that is concluded using fraudulent cards shall lose its validity as of
the start of the Company¡¯s liability.
¨è Fraudulent cards as specified in Clause ¨ç, Article 3 herein refer to expired cards, forged
or altered cards, cards used for transactions whose nullification or suspension is disclosed,
or cards bearing names that are different from those of the users.
Article 4 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Additional Provisions on Error in Date Recognition
Article 1
Notwithstanding the terms and conditions of the general provisions and special provisions,
the Company shall not compensate for direct and indirect losses --regardless of whether the
Insured (the Policyholder) owns the equipment -- that occurred when a certain date cannot be
recognized, processed, distinguished, interpreted, or accepted as the accurate calendar date
in a computer, a data processor, an operating system, a micro processor, an integrated circuit
and similar devices, or computer software - in its use - or related produced goods, services,
information, or function.
Article 2
The company shall not compensate for the expenses incurred in repair or modification to
correct the defect or logic of EDPS or related devices with regard to Article 1 herein.
Article 3
The company shall not compensate for the damages and consequent losses due to advice,
direction, evaluation of design, inspection of installation, maintenance, error in repair and
supervision, inappropriateness, or malfunction brought upon himself/herself or another person
by the Insured (the Policyholder) or received from others to verify, modify, or test the potential
or practical fault, malfunction, or non-effectiveness.
Article 4
The Company shall not compensate for the damages and consequent losses described in
Articles 1, 2, and 3 herein, even if they are combined or related to other causes of accident.
Special provisions on the applied exchange rate
Article 1 (Insurance Premiums Application Standard)
When receiving or refunding the insurance premium, Korean won as calculated according to
the 1 st notice of telegraphic transfer selling rate to customers by Korea Exchange Bank on the
day of application or endorsement should be used.
¨ç Insurance premiums: application date
¨è Additional or refunded insurance premiums: Endorsement date
¨é Refund: Termination date
¨ê Insurance premiums installment: Payment date
Article 2 (Payment standard of Insurance Money)
Insurance premiums shall be paid in Korean won or ( ) as calculated according to the 1 st
notice of telegraphic transfer selling rate to customers by Korea Exchange Bank on the day of
payment.
Article 3 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions
Special Provisions on the Designated Claim Agent Service
Article 1 (Application Eligibility)
These special provisions govern the general provisions and special provisions wherein the
Policyholder, the Insured (Covered Person) and the Beneficiary (Recipient of Insurance
Money) are the same.
Article 2(Conclusion and Expiration of Special Provisions)
¨ç These Special Provisions are added upon the application of the insurance policyholder and
acceptance of the insurance company. ("Insurance Policyholder" to be referred to as
"Policyholder," and "Insurance Company," as "Company" hereinafter).
¨è In case the insurance contract pursuant to Article 1 (Application Eligibility) has lost
effectiveness due to termination or other reasons, these special provisions are no longer
valid.
Article 3 (Designation of Claim Agent)
¨ç When concluding the contract, the Policyholder may designate (including change and
designation pursuant to Article 4 herein) one of the following person as claim agent
(hereinafter referred to as " Designated Claim Agent") for the insurance money in case
he/she is unable to claim the insurance money specified in the general provisions or
special provisions. (The Designated Claim Agent should be one of the following persons,
when claiming the insurance money):
1. A spouse, according to Family Relation Register or resident registration of the Insured
(Covered Person), who lives together or shares the economic lives with the Insured
(Covered Person)
2. A person who is an uncle/aunt or in the same or closer degree of kinship with the Insured
(Covered Person) and who lives together or shares an economic life with the Insured
(Covered Person)
¨è Notwithstanding Clause ¨ç, Article 3 herein, the Designated Claim Agent shall
automatically lose his/her status if the Beneficiary (Recipient of Insurance Money) in
Article 1 (Application Eligibility) is changed.
Article 4 (Change of Designated Claim Agent)
The Policyholder may submit the following documents and change the Designated Claim
Agent; (the change in designation shall be indicated in writing or written at the back of the
insurance policy (insurance certificate)).
1. Application for change of Designated Claim Agent (company form)
2. The insurance policy (insurance certificate)
3. Family Relation Register or resident registration of the Designated Claim Agent (basic
certificate, etc.)
4. Identification cards (identification cards issued by the government, e.g., resident
registration card or driver¡¯s license with photo attached including certificates of official
seal impression in case the Policyholder is not the Beneficiary himself/herself)
Article 5 (The Procedure for Insurance Money Payment, Etc.)
¨ç The Designated Claim Agent may claim and receive the insurance money (except death
benefits) as an agent of the Beneficiary (Recipient of Insurance Money) when he/she
submits a document specified in Article 6 (Documents Required for Insurance Claims,
Etc.) to prove that the existence of special circumstance wherein the Beneficiary
(Recipient of Insurance Money) in Article 1 (Application Eligibility) cannot claim the
insurance money by himself/herself and obtains the Company's approval.
¨è In case it already paid the insurance money to the Designated Claim Agent, the Company
shall not pay insurance money even upon receiving the corresponding claim.
Article 6 (Documents Required for Insurance Claims, etc.)
The Designated Claim Agent should submit the following documents and claim insurance
money according to the method specified by The Company.
1. Applications (Company-specified forms)
2. Proof of accident
3. Identification cards (identification cards issued by the Government, e.g., resident
registration card or driver¡¯s license with photo attached
4. Certificates of official seal impression of the Insured (Covered Person)
5. Family Relation Register (certificate of family relationship) or resident registration of the
Insured (Covered Person) or the Designated Clam Agent
6. Other documents submitted by the Designated Clam Agent as necessary for the receipt
of insurance premiums
Article 7 (Application of the Provisions)
Other matters that are not stipulated in these Special Provisions shall be governed by the
General Provisions and the relevant Special Provisions
Special Agreement for Insurance for Actual Medical Expenses
during Overseas Travel
The insurance for actual medical expenses during overseas travel is a product for the
insurance company to compensate for medical costs paid by the insured (covered person)
due to his/her injury or disease during overseas travel
Chapter 1 General matters
Article 1 (Covered item) The special agreement for insurance for actual medical costs
during overseas travel to be covered by the company comprises three covered items--
medical expenses for injuries, medical expenses for diseases and general (refers to
injuries and diseases) medical expenses as follows and the policyholder may select
one or more of these three covered items when making a contract.
Covered
item
Detailed
components
Overseas
Content of compensation
Compensation for medical expenses for overseas medical
institutions (note) incurred by the insured(covered person) due to
injuries of the insured(covered person) suffered during overseas
due to
Medical
expenses
for
injuries
travel
Hospitaliz Compensation for medical expenses for hospitalization incurred
ation due by the insured(covered person) due to injuries of the
to injuries insured(covered person) suffered during overseas travel
In
Korea Ambulato Compensation for medical expenses for ambulatory care or
ry care filling prescriptions incurred by the insured(covered person) due
to injuries of the insured(covered person) suffered during
injuries
Overseas
overseas travel
Compensation for medical expenses for overseas medical
institutions (note) incurred by the insured(covered person) due to
diseases of the insured(covered person) contracted during
overseas travel
In
Medical
expenses
for
diseases
Hospitali
zation
due to
diseases
Compensation for medical expenses for hospitalization incurred
by the insured(covered person) due to diseases of the
insured(covered person) contracted during overseas travels
ry care
due to
Korea Ambulato Compensation for medical expenses for ambulatory care or
filling prescriptions incurred by the insured(covered person) due
to diseases of the insured(covered person) contracted during
diseases overseas travel
In
Korea
General
medical
expenses
Overseas
General
hospitaliz
ation
Compensation for medical expenses for overseas medical
institutions (note) incurred by the insured(covered person) due to
injuries or diseases of the insured(covered person) suffered or
contracted during overseas travel
Compensation for medical expenses for hospitalization incurred
by the insured(covered person) due to injuries or diseases of the
insured(covered person) suffered or contracted during overseas
travel
ambulato
ry care
Compensation for medical expenses for ambulatory care or
filling prescriptions incurred by the insured(covered person) due
to injuries or diseases of the insured(covered person) suffered or
contracted during overseas travel
(Note) Overseas medical institutions refer to medical institutions including pharmacies located
overseas. This will remain the same hereinafter.
Article 2 (Definitions of terms) The definitions of the terms used in this agreement are as
shown in and the relevant terms are indicated in this agreement underlines.
Chapter 2 Cases to be compensated for by the company
Article 3 (Cases compensated for by covered item) Cases to be compensated by the
company during the insurance period under this contract are as follows by covered
item.
-1
Covered
item
Medical
expenses
for injuries
Detailed
component
Overseas
Cases to be compensated
¨ç In case the insured(covered person) suffered injuries during
the overseas travel written in the insurance policy (insurance
certificate) and was treated by doctors in overseas medical
institutions (limited to the hospitals and qualified doctors as
specified under the laws of the country where the treatment
was conducted) due to the injuries, the company will
compensate for the full amount of the medical expenses
actually paid by the insured(covered person) up to the
insured amount.
¨è Notwithstanding the provision in Clause ¨ç , medical
expenses for disk finger pressure therapy (such as
chiropractic or other disk therapy) or for acupuncture
(including vena-TX and moxa-TX) shall be compensated for
only when such treatment is administered by the hospital
and/or doctors licensed in accordance with the laws of the
country of treatment and within the limit of USD 1,000.00 per
injury.
¨é The injuries set forth under item ¨ç include toxic symptoms
resulting from toxic gases or toxic substances abruptly
inhaled, absorbed or taken by chance. However, bacterial
food poisoning and toxic symptoms resulted from habitual
inhalation, absorption or intakes are not included.
¨ê In case the insurance period was expired while the
insured(covered person) was being treated due to the
injuries suffered during overseas travel, the relevant
expenses for up to 90 days after the expiry date of the
insurance period (excluding the date of expiry of the period
of insurance) will be compensated for.
¨ç In case the insured(covered person) suffered injuries during
the overseas travel written in the insurance policy (insurance
certificate) and was treated in medical institutions or
pharmacies in Korea due to the injuries, the company will
compensate pursuant to ; provided that, in
case the insurance period is shorter than one year, if the
insurance period was expired while the insured (covered
In Korea
person) was being treated due to the injuries suffered during
overseas travel, the relevant expenses for up to 90days
(excluding the date of expiry of the period of insurance) after
the expiry date of the insurance period(90 days for
ambulatory care, 45 times for ambulatory treatment and 45
cases for prescription filling) (excluding the date of expiry of
the period of insurance) will be compensated for.
¨ç In case the insured (covered person) was treated by doctors
in overseas medical institutions (limited to the hospitals and
qualified doctors as specified under the laws of the country
where the treatment was conducted) due to diseases during
the overseas travel written in the insurance policy (insurance
certificate), the company will compensate for the full amount
of the medical expenses actually paid by the insured
(covered person) up to the insured amount.
¨è Notwithstanding the provision in Clause ¨ç , medical
expenses for disk finger pressure therapy (such as
chiropractic or other disk therapy) or for acupuncture
(including vena-TX and moxa-TX) shall be compensated for
-2
Medical
expenses
for
diseases
-2
Medical
expenses
for diseases
Overseas
In Korea
only when such treatment is administered by the hospital
and/or doctors licensed in accordance with the laws of the
country of treatment and within the limit of USD 1,000.00
per injury.
¨é The diseases set forth under item ¨ç do not include any
diseases corresponding to the ¡®obligation to notify before
making a contract(limited to important matters)¡¯ under the
application for the contract that were diagnosed or treated in
the past (Refers to the periods for notice of the relevant
diseases).
¨ê In case the insurance period was expired while the
insured(covered person) was being treated due to the
diseases mentioned under item ¨ç, the relevant expenses
for up to 90 days after the expiry date of the insurance
period(excluding the date of expiry of the period of
insurance) will be compensated for.
¨ç In case the insured(covered person) was treated in medical
institutions or pharmacies in Korea due to diseases
contracted during the overseas travel written in the
insurance policy (insurance certificate), the company will
compensate pursuant to ; provided that, in
case the insurance period is shorter than one year, if the
insurance period began to be treated within 30 days after the
expiry of the insurance period due to diseases (excluding
any diseases corresponding to the ¡®obligation to notify before
making a contract(limited to important matters)¡¯under the
application for the contract that were diagnosed or treated in
the past (Refers to the periods for notice of the relevant
diseases) ) contracted during overseas travel, the relevant
expenses for up to 90days (including the date on which the
treatment began) from the date the treatment by the doctor
began (90 days for ambulatory care, 45 times for ambulatory
treatment and 45 cases for prescription filling) will be
compensated for.
Overseas
¨ç ¡®Medical expenses for injuries¡¯ shall apply to injuries.
¨è ¡®Medical expenses for diseases¡¯ shall apply to diseases.
¨ç In case the insured(covered person) was treated in medical
institutions or pharmacies in Korea due to injuries or
diseases suffered or contracted during the overseas travel
written in the insurance policy(insurance certificate), the
company will compensate pursuant to .
However, in case the insurance period is shorter than one
year, if the insurance period was expired while the insured
(covered person) was being treated due to the injuries
suffered during overseas travel, the relevant expenses for
up to 90 days (excluding the date of expiry of the period of
-3
General
medical
expenses
In Korea
insurance) after the expiry date of the insurance period (90
days for ambulatory care, 45 times for ambulatory treatment
and 45 cases for prescription filling) (excluding the date of
expiry of the period of insurance) will be compensated for,
and if the insured (covered person) began to be treated
within 30 days after the expiry of the period of insurance due
to diseases (excluding any diseases corresponding to the
¡®obligation to notify before making a contract (limited to
important matters)¡¯under the application for the contract that
were diagnosed or treated in the past (Refer to the periods
for notice of the relevant diseases)) contracted during
overseas travel, the relevant expenses for up to 90 days
(including the date on which the treatment began) from the
date the treatment by the doctor began (90 days for
ambulatory care, 45 times for ambulatory treatment and 45
cases for prescription filling) will be compensated for.
Chapter 3 Cases not to be compensated for by the company
Article 4 (Cases not to be compensated for) Cases not to be compensated for by the
company are as follows.
Covered
item
-1
Medical
expenses
for injuries
-1
Medical
expenses
for injuries
Detailed
component
Overseas
Overseas
Cases not to be compensated for
¨ç The company will not compensate for medical expenses arising
from the following causes:
1. Beneficiary¡¯s intention. However, if the beneficiary is one of
multiple beneficiaries of the insurance money, the remaining
insurance money excluding the insurance money
corresponding to the beneficiary will be paid to other
beneficiaries.
2. Policyholder¡¯s intention
3. Intention of the insured (covered person). However, if the fact
that the insured (covered person) injured himself/herself in a
condition of being unable to make free decisions because
he/she was non compos mentis has been proved, the relevant
expenses will be compensated for.
4. Cases where the insured (covered person) was treated due to
pregnancy, parturition (including caesarian section) or
puerperium. However, treatments for the kinds of injuries
specified to be compensated for by the company will be
compensated for.
5. War, foreign country¡¯s use of armed force, revolution,
insurrection, incident, riot
6. In case the insured (covered person) did not follow doctor¡¯s
instructions during the period of hospitalization or ambulatory
care, the company will not compensate for the expenses for
the portion deteriorated due to the foregoing actions.
¨è Unless agreed to otherwise, the company will not compensate
for injuries resulting from any of the acts listed below conducted
by the insured(covered person) for the sake of his/her
occupation, duty or club activity:
1. Professional climbing(refers to climbing rock walls or ice ridges
using special climbing equipment or those kinds of climbing
that require special skills, experience and prior training),
gliding, skydiving, scuba diving and hang-gliding
2. Competitions, demonstrations or entertainment using motor
boats, cars or motorcycles(including practices for these) or
test runs(however, injuries suffered during test runs on public
roads will be compensated for)
3. Onboard a ship as a profession, e.g., crewmember, fisherman,
boatman, etc.
¨é The company will not compensate for any of the medical
expenses listed below:
1. Medical expenses for health inspections, vaccinations or
induced abortions. However, if the treatments are for the
purpose of treating injuries, they will be compensated for.
2. Expenses spent for administration of nutrients, multiple
vitamins, hormones or tonic medicines, diagnoses for
paternity identifications, infertility inspections, sterilizations,
restorations from sterility, assisted reproductive operations
(including internal fecundations and external fecundations) or
growth promotion. However, if the treatments are for the
purpose of treating injuries, they will be compensated for.
Medical
expenses
for injuries
Overseas
In Korea
3. Expenses to buy or replace treatment materials such as
abutments, artificial hands or legs, artificial eyes, glasses,
contact lenses, hearing aids, crutches, arm slings or aids
(However, items that are implanted in the body to replace
organs such as artificial organs or partial dentures are
exceptional.)
4. Medical expenses arising from treatments for the purpose of
improvements of outward appearance.
a. Double eyelid formation, rhinoplasty(augmentation rhino
plasty), breast augmentation/reduction, suction lipectomy,
rhitidectomy, etc.
b. Visual system operations for improvements of outward
appearance but not for improvements of eyesight such as
revisions of tropia or orbital hypertelorism
c. Orthoptics to replace glasses or contact lenses
d. Leg varix operations for the purpose of improvements of
outward appearance
5. All other expenses not related to treatments (TV subscription
fees, telephone charges, various certificate fees etc),
inspection expenses not related to doctors¡¯ clinical findings
¨ç will be applied.
¨ç The company will not compensate for medical expenses arising
from the following causes:
1. Beneficiary¡¯s intention. However, if the beneficiary is one of
multiple beneficiaries of the insurance money, the remaining
insurance money excluding the insurance money
corresponding to the beneficiary will be paid to other
beneficiaries.
2. Policyholder¡¯s intention
3. Intention of the insured (covered person). However, if the fact
that the insured (covered person) injured himself/herself in a
condition of being unable to make free decisions because
he/she was non compos mentis has been proved, the relevant
-2
Medical
expenses
for diseases
expenses will be compensated for.
4. In case the insured (covered person) did not follow doctor¡¯s
instructions during the period of hospitalization or ambulatory
care, the company will not compensate for the expenses for
the portion deteriorated due to the foregoing actions.
Overseas ¨è The company will not compensate for any of the following
medical expenses set forth under the 5 th Korea Standard
Disease Cause Classification.
1. Psychiatric disorders and behavior disorders (F04~F99)
2. Habitual abortions due to non-inflammatory disorders of female
genital organs, infertility or artificial fertilization related
complications(N96~N98)
3. Treatments of the insured (covered person) due to pregnancy,
parturition (including cesarean sections) or puerperium
(O00~O99)
4. Congenital brain diseases (Q00~Q04)
5. Obesity (E66)
6. Urinary system disorders(N39, R32)
7. Some of rectal or anal diseases that do not correspond to the
treatment fees under the National Health Insurance Act (I84,
K60~K62
¨é The company will not compensate for any of the medical
expenses listed below:
1. Medical expenses arising from dental treatment such as dental
prosthesis, conservative treatment, cap crown, denture,
abutment, and dental implant.
2. Medical expenses for health inspections, vaccinations or
induced abortions. However, if the treatments are for the
purpose of treating diseases, they will be compensated for.
3. Expenses spent for administration of nutrients, multiple
vitamins, hormones or tonic medicines, diagnoses for
paternity identifications, infertility inspections, sterilizations,
restorations from sterility, assisted reproductive operations
(including internal fecundations and external fecundations) or
growth promotion. However, if the treatments are for the
purpose of treating diseases, they will be compensated for.
4. Medical expenses arising from any of the treatments listed
below:
a. Simple fatigue or malaise
b. Freckle, hirsutism, atrichia, poliosis, rosacea, nevus, wart,
acne, cutaneous disorders due to aging effects such as
alopecia
c. Impotence sex frigidity, simple snore, simple phimosis
-2
Medical
expenses
for diseases
Overseas
d. Leg varix operations for the purpose of improvements of
outward appearance
5. Expenses to buy or replace treatment materials such as
abutments, artificial hands or legs, artificial eyes, glasses,
contact lenses, hearing aids, crutches, arm slings or aids
(However, items that are implanted in the body to replace
organs such as artificial organs or partial dentures are
exceptional.)
6. Medical expenses arising from treatments for the purpose of
improvements of outward appearance.
a. Double eyelid formation, rhinoplasty(augmentation rhino
plasty), breast augmentation/reduction, suction lipectomy,
rhitidectomy, etc.
b. Visual system operations for improvements of outward
appearance but not for improvements of eyesight such as
revisions of tropia or orbital hypertelorism
c. Orthoptics to replace glasses or contact lenses
d. Leg varix operations for the purpose of improvements of
outward appearance
7. All other expenses not related to treatments (TV subscription
fees, telephone charges, various certificate fees etc),
inspection expenses not related to doctors¡¯ clinical findings
8. Treatment expenses due to human immunodeficiency virus
(HIV) infection (However, cases objectively confirmed through
relevant treatment records where medical workers were
infected with HIV through blood during treatments will be
excluded)
In Korea ¨ç will be applied
Medical
expenses
for diseases
-3
General
medical
expenses
Overseas
In Korea
¨ç ¡®(1) Medical expenses for injuries¡¯ will be applied to injuries.
¨è ¡®(2) Medical expensed for diseases¡¯ will be applied to diseases.
¨ç ¡®(1) Medical expenses for injuries¡¯ will be applied to injuries.
¨è ¡®(2) Medical expensed for diseases¡¯ will be applied to diseases.
Chapter 4 Treatment of multiple insurance contracts, etc.
Article 5 (Treatment of multiple insurance contracts, etc.) ¨çIn the case of multiple
insurance contracts, the proportional shares of individual contracts calculated as per item 3
based on the medical expenses to be compensated and the liable compensation amounts of
the individual contracts will be paid as liable compensation amounts.
¨èThe total amount of the liable compensation amounts to be paid for individual contracts as
proportional shares shall be limited to the largest amount of the medical expenses to be
compensated of the individual contracts at the maximum.
¨éFor any multiple insurance contracts for which the total amount of the liable compensation
amounts of the individual contracts exceeded the largest amount of the medical expenses to
be compensated of the individual contracts, the proportional shares of the medical expenses
to be compensated of the individual contracts will be paid and the proportional shares of
multiple insurance contracts will be calculated as follows. In this case, expenses for
hospitalization, ambulatory care and prescription filling will be separately calculated.
Proportional shares of individual contracts =
The largest amount among the medical
expenses to be compensated of the ¡¿
contracts
Liable compensations amounts of individual
contracts
Total of the liable compensation amounts of
individual contracts
Article 6 (Joint liability) ¨çIn the case of multiple insurance contracts with the same beneficiary
newly made on October 1, 2009 or thereafter, the beneficiary may request one of the
companies with which multiple insurance contracts have been made to pay all or part of
insurance money and the company that received the request will pay the relevant insurance
money within the insured amount of the contract.
¨èThe company that paid the insurance money pursuant to item 1 shall obtain the right to
request insurance money from other companies possessed by the beneficiary; provided that,
if the amount compensated by the company is a part of the insurance money that may be
requested by the beneficiary to other companies, the company will obtain the right to the
extent of not infringing the right of claim of the relevant beneficiary.
Article 7 (Presentation of the Provisions and Duty to Explain) In addition to Article 3
(Presentation of the Provisions and Duty to Explain) of the General Provisions, the company
shall check whether the insured (covered person) is covered by other Insurance for Actual
Medical Expenses and when applicable, explains the compensation to him/her.
Article 8 (Application of the Provisions) Other matters that are not stipulated in these Special
Provisions shall be governed by the General Provisions
Definition of terms
Injuries
Doctor
Terms
Contract
Policyholder
The insured
(covered person)
Beneficiary
Insurance period
The company
During overseas
travel
Injury insurance
contract
Pharmacist
Medical institution
Pharmacy
Hospital
Hospitalization
Medical institution
recognized to be
equivalent to a
hospital in the
definition of
hospitalization
Standard
sickroom
Sickroom charge
Definition
Insurance contract
The person who makes contracts with insurance companies and pays
insurance premiums.
The person who is the object of reasons for insurance money payments
or the occurrence of insurance accidents.
The person who receives insurance money
The period during which risks of the object specified under the contract
are covered
Insurance company
The period beginning from the time when the insured (covered person)
leaves his/her dwelling site for the purpose of the travel written in the
insurance policy (insurance certificate) and ending at the time when the
insured (covered person) arrives at his/her dwelling site after finishing
the travel.
Sudden and casual accidents occurred during the period of insurance
Contract to cover injuries
A person having the qualification of a doctor, an Oriental doctor or a
dentist as specified under Article 2 (medical worker) of the medical
service law
A person having the qualification of a pharmacist or an Oriental
pharmacist as specified under Article 2 (definition) of the pharmacist law
Any of the medical institutions as specified under Article 3 (medical
institution) of the medical service law which are divided into general
hospitals ¡¤ hospitals ¡¤ dental hospitals ¡¤ Oriental hospitals ¡¤
preventoriums ¡¤ clinics ¡¤ dental clinics¡¤ Oriental medicine clinics and
maternity hospitals (excluding overseas medical institutions)
A place specified by the provision under item 3 of Article 2 of the
pharmacist law where pharmacists compound drugs to be provided and
compounding rooms in medical institutions are excluded
Any of the hospitals or clinics in Korea as specified under Article 40
(treatment institution) of the National Health Insurance Act (excluding
maternity hospitals)
Cases where any doctor acknowledged that the covered person should
be treated due to diseases or injuries and since the treatment is difficult
at home, etc., the covered person was admitted to a hospital or any
other medical institution recognized to be equivalent to a hospital for
devotion to treatment under the care of doctors.
Any medical institution falling under the medical institutions specified
under item 2 of Article 3 (medical institution) of the medical service law
such as public health centers, public medical centers and public health
centers¡¯ branches except for any institutions that are not the medical
institutions such as military medical corps, nursing homes belonging to
dementia nursing homes or elderly person nursing homes, nursing
facilities and welfare facilities.
A sickroom that is the standard applied by hospitals to hospitalized
national health insurance patients
Standard sickroom use charges occurred during hospitalized treatments,
this refers to patient care charges, meal charges, etc.
This refers to the examination charges, test charges, radiology charges,
medication and prescription charges, injection charges, physical therapy
hospitalization
expenses
Hospitalized
operation
expenses
Medical
expenses for
hospitalization
Ambulatory
treatment
Prescription filling
Various
ambulatory
treatment
expenses
Ambulatory
operation
expenses
Prescription filling
expenses
Ambulatory
medical expenses
Treatment fees
Medical benefits
(physical therapy, rehabilitation therapy) charges, psychotherapy
charges, treatment charges, material charges, cast charges and
designated care charges etc occurred during hospitalization
These refer to the operation charges, anesthesia charges, operation
material expenses, etc. occurred during hospitalized treatments
These consist of sickroom charges, various hospitalization expenses,
hospitalized operation charges and amount differences for higher
grade sickrooms.
Cases where any doctor acknowledged that the insured (covered
person) should be treated due to diseases or injuries and the covered
person visits the hospital for devotion to treatments under the care of
doctors without being hospitalized
Cases where any doctor or pharmacist acknowledged that the covered
person should be treated due to diseases or injuries and any pharmacist
of any pharmacy fills prescriptions issued by doctors through ambulatory
treatments (including prescription fillings at the Korea Orphan Drug
Center pursuant to point 3 of item 1 of Article 40 of the National Health
Insurance Act and direct compounding by pharmacists in regions from
the separation of dispensary from medical practice)
These refer to the examination charges, test charges, radiology charges,
medication and prescription charges, injection charges, physical therapy
(physical therapy, rehabilitation therapy) charges, psychotherapy
charges, treatment charges, material charges, cast charges and
designated care charges etc occurred during ambulatory treatments
These refer to the operation charges, anesthesia charges, operation
material expenses, etc. occurred during ambulatory treatments
These refer to the pharmacy¡¯s prescription filling expenses for drugs
compounded per hospital doctors¡¯ prescriptions and pharmacists¡¯ direct
compounding expenses
These consist of various ambulatory treatment expenses, ambulatory
operation expenses and prescription filling expenses
These refer to the treatment fees under the following points for the
diseases or injuries of the insured and his/her dependents pursuant to
Article 39 (treatment fee) of the National Health Insurance Act.
1. Examinations and tests
2. Provision of drugs and treatment materials
3. Dressing, operation and other treatments
4. Prevention and rehabilitation
5. Hospitalization
6. Nursing
7. Transportation
These refer to the medical benefits under the following points for the
diseases or injuries of the insured and his/her dependents pursuant to
Article 7 (Coverage of Medical benefits) of the Medical Care Assistance
Act
1. Examinations and tests
2. Provision of drugs and treatment materials
3. Dressing, operation and other treatments
4. Prevention and rehabilitation
5.Hospitalization
6. Nursing
7. Transportation and other measures needed for medical purposes
This refers to the system where, in case the total annual amount of
Patients¡¯ share
limit system
under the
National Health
Insurance Act
Patients¡¯ share
compensation
system and limit
system under the
Medical Care
Assistance Act
patients¡¯ share of the treatment fees under the National Health
Insurance law exceeds the amount specified by attached table 3 of the
enforcement decree of the National Health Insurance law, the National
Health Insurance Corporation pays the exceeding amount and if the
refund criteria are changed due to any changes in laws relating to
national health insurance, the company will observe the changed criteria
This refers to the system where, in case the total amount of patients¡¯
share of the medical benefits exceeds the amount specified by Article 13
(share of medical benefits) of the enforcement decree of the Medical
Care Assistance Act, the Medical Care Assistance Fund pays the
exceeding amount and if the refund criteria are changed due to any
changes in laws relating to national health insurance, the company will
observe the changed criteria
to be
Medical expenses
Actually paid amount - amount excluded from compensations
compensated for
Liable amount of
compensation
Multiple
insurances
(Actually paid amount - amount excluded from compensations) ¡¿ rate of
payments by the company
These refers to two or more (multiple) actual medical expense insurance
contracts (including insurance and fraternal insurance contracts to
compensate actual medical expenses such as 3 rd insurance including
post office insurance, various kinds of fraternal insurance,
injury ¤ý disease ¤ý nursing insurance and private pension ¤ý retirement
insurance) that have been made simultaneously or in sequence and,
respectively, have liable amounts to compensate for the same insurance
accident.
Medical expenses for injuries that are to be
compensated out of medical expenses in medical
institutions in Korea
Division
Cases to be compensated
¨ç When the insured (covered person) was hospitalized and treated due to injuries,
the company will compensate for the medical expenses for hospitalization up to
the insured amount per injury (the amount determined by the policyholder
within the maximum limit of 50 million won) as follows.
Division
Sickroom
charges,
various
hospitalizatio
n expenses,
hospitalized
operation
expenses
Amount
difference for
higher grade
sickrooms
Amount to be compensated
The amount equal to 90% of the sum of ¡®the patient¡¯s share out of the
treatment fees specified under the National Health Insurance law or
medical benefits under the Medical Care Assistance Act¡¯ and the ¡®non-
payable expenses(excluding amount differences for higher grade
sickrooms)¡¯(However, if the amount equal to the remaining 10% exceeds
2 million won for one year from the date of contract or each anniversary
of the date of contract, the exceeding amount will be compensated))
The amount of 50% of the amount difference between the sickroom
actually used during hospitalization and the standard sickroom
(However, the amount will be limited to the amount calculated based on
the daily average amount of 100,000 won at the maximum and the daily
average amount is to be calculated by dividing the total of the higher
grade sickroom charge for the entire hospitalization period by the entire
days of hospitalization.)
Hospitaliz
ation due
to injuries
¨è The injuries set forth under item ¨ç include toxic symptoms resulting from toxic
gases or toxic substances abruptly inhaled, absorbed or taken by chance.
However, bacterial food poisoning and toxic symptoms resulted from habitual
inhalation, absorption or intakes are not included.
¨é In case the National Health Insurance law or Medical Care Assistance Act is not
applicable to the insured(covered person), (including cases where the
procedures required for treatment fees specified under the National Health
Insurance law or medical benefits under the Medical Care Assistance Act were
not gone through), the amount equal to 40% of the amount actually paid by the
insured (covered person) will be deemed to be the maximum amount of the
insured amount per injury (the amount determined by the policyholder within the
maximum limit of 50 million won per injury) to be compensated.
¨ê The company will compensate for up to 365 days from the first date of
hospitalization (including the first date of hospitalization) for expenses for
hospitalization for one injury (Cases where the same injury is treated two or
more times will also be deemed to be one injury.). However, in case the
insured(covered person), is hospitalized for longer than 365 days from the first
date of hospitalization due to the same injury, the injury will be deemed to be a
new injury and compensated again only when the 90-day period of exclusion
from compensation has passed as shown below.
Period to be
compensated
(365 days)
Exclusion
from
compensation
(90 days)
Period to be
compensated
(365 days)
st
Hospitaliz
¡è
Contract date
(2010.1.1)
¡è
1 date of
hospitalization
(2010.3.1)
¡è
(2011.2.28)
Excluded from
compensation
from 2011.3.1.
¡è
(2011.5.29)
Compensation
will be resumed
from 2011.5.30
¡è
(2012.5.29)
Excluded from
compensation
from 2012.5.30.
ation due
to injuries ¨ë Even if the insurance period expires while the insured (covered person) is
hospitalized for treatment, the continued hospitalization will be compensated
for up to 180 days after the expiry date of the insurance period (excluding the
expiry date of the insurance period. However, item 4 will not be applied to this
case.
¨ì If the medical expenses to be paid by the insured (covered person) were
reduced by any employee welfare system of the hospital, the medical
expenses for hospitalization will be calculated based on the medical expenses
before the reduction.
¨ç When the insured(covered person) received ambulatory treatments or
prescription fillings due to injuries, the company will compensate for
ambulatory treatment expenses (various ambulatory treatment expenses,
ambulatory operation expenses) and prescription filling expenses as medical
expenses for ambulatory treatments as follows based on one year from the
date of each year corresponding to the date of contract.
Division
Limit of compensation
Ambulato
ry care
due to
injuries
Ambulatory
treatment
Expenses
for
prescription
filling
The amount of the sum of ¡®the patient¡¯s share out of the treatment fees
specified under the National Health Insurance law or medical benefits
under the Medical Care Assistance Act¡¯ and the ¡®non-payable expenses¡¯
less £¼Table 1 amounts to be deducted by item£¾ will be compensated
per visit up to the insured amount for ambulatory treatments note) (up to
180 visits per year from the date corresponding to the date of contract in
each year)
The amount of the sum of ¡®the patient¡¯s share out of the treatment fees
specified under the National Health Insurance law or medical benefits
under the Medical Care Assistance Act¡¯ and the ¡®non-payable expenses¡¯
less £¼Table 1 amounts to be deducted by item£¾ will be compensated
per prescription up to the insured amount for expenses for prescription
filling note) (up to 180 prescriptions per year from the date corresponding to
the date of contract in each year)
Note) Expenses for ambulatory treatments and prescription fillings shall be
determined by the policyholder within the maximum limit of the sum of
300,000 won per visit (prescription).
£¼Table 1 Amounts to be deducted by item£¾
Divis on
Ambulatory
treatment
(sum of
various
ambulatory
treatment
expenses
and
ambulatory
operation
expenses)
Expenses
for
prescription
filling
Item
Clinics, dental clinics and Oriental medicine clinics
under paragraph 1, item 2 of Article 3 of the Medical
Service law; maternity hospitals under paragraph 2,
item 2 of Article 3 of the Medical Service law; public
health centers under Article 7 of the Regional Health
law; public health medical centers under Article 8 of the
Regional Health law; public health centers¡¯ branches
under Article 10 of the Regional Health law; public
health clinics under Article 15 of the Special Action law
for the health and medical services for agricultural or
fishing villages
General hospitals, hospitals, dental hospitals, oriental
hospitals, and treatment hospitals under paragraph 3,
item 2 of Article 3 of the Medical Service law
General specialized nursing facilities under item 2 of
Article 40 of the National Health Insurance law or
Superior general hospital under Article 3-4 of Medical
Service law
Pharmacies under point 2 of item 1 of Article 40 of the
National Health Insurance law, prescriptions at the
Korea Orphan Drug Center under point 3 of item 1 of
Article 40 of the said law, compounding (per
prescription of a doctor, per direct compounding by a
pharmacist in regions exceptional from the separation
of dispensary from medical practice)
Amount to
be deducte
10,000 won
15,000
won
20,000 won
8,000 won
¨è Even if the insurance period expires while the insured (covered person) is
receiving ambulatory treatments, the continued ambulatory treatments will be
compensated for up to 180 days after the expiry date of the insurance period
up to 90 visits for ambulatory treatments and 90 prescriptions for expenses for
prescription filling.
Period to be
compensated
(1year)
Period to be
compensated
(1year)
Period to be
compensated
(1year)
Additional
compensation
(180days
¡è
Date of
contract
(2010.1.1)
¡è
Date
corresponding
to the date of
contract
¡è
Date
corresponding
to the date of
contract
¡è
Expiry date of
the insurance
period
(2012.12.31)
¡è
Ending of
compensation
(2013.6.29.)
(20 1.1.1)
(2012.1.1)
¨é Two or more ambulatory treatments at a medical institution in a day due to one
injury (including two or more prescription fillings at a pharmacy due to one
injury) will be deemed to be one ambulatory treatment or one prescription and
items 1 and 2 shall apply.
¨ê The injuries set forth under item ¨ç include toxic symptoms resulting from toxic
gases or toxic substances abruptly inhaled, absorbed or taken by chance.
However, bacterial food poisoning and toxic symptoms resulted from habitual
inhalation, absorption or intakes are not included.
¨ë In case the National Health Insurance law or Medical Care Assistance Act is
not applicable to the insured(covered person), (including cases where the
procedures required for treatment fees specified under the National Health
Insurance law or medical benefits under Medical Care Assistance Act were not
gone through), the amount equal to 40% of the amount actually paid by the
insured (covered person) out of the ambulatory medical expenses and
expenses for prescription filling will be compensated up to the insured
amount(the amount of ambulatory medical expenses and expenses for
prescription filling per visit(prescription) determined by the policyholder within
the maximum limit of 300,000 won).
¨ì If the medical expenses to be paid by the insured (covered person) were
reduced by any employee welfare system of the hospital or pharmacy, the
medical expenses for ambulatory treatment will be calculated based on the
medical expenses before the reduction
Medical expenses for diseases that are to be
compensated out of medical expenses in medical
institutions in Korea
Division
Cases to be compensated
¨ç When the insured (covered person) was hospitalized and treated due to
diseases, the company will compensate for the medical expenses for
hospitalization up to the insured amount per disease (the amount determined
by the policyholder within the maximum limit of 50 million won).
various
Division
Sickroom
charges,
hospitalization
expenses,
hospitalized
operation
expenses
Amount
difference for
higher grade
sickrooms
Amount to be compensated
The amount equal to 90% of the sum of ¡®the patient¡¯s share out of the
treatment fees specified under the National Health Insurance law or
medical benefits under the Medical Care Assistance Act¡¯ and the ¡®non-
payable expenses(excluding amount differences for higher grade
sickrooms)¡¯(However, if the amount equal to the remaining 10%
exceeds 2 million won for one year from the date of contract or each
anniversary of the date of contract, the exceeding amount will be
compensated))
The amount of 50% of the amount difference between the sickroom
actually used during hospitalization and the standard sickroom
(However, the amount will be limited to the amount calculated based
on the daily average amount of 100,000 won at the maximum and the
daily average amount is to be calculated by dividing the total of the
higher grade sickroom charge for the entire hospitalization period by
¡®obligation to notify before a contract¡¯ (limited to important matters) under the
to
diseases
the entire days of hospitalization.)
Hospitaliz ¨è From the diseases set forth under item 1, the diseases corresponding to the
ation due
application that were diagnosed or treated in the past (this refers to the period
to be notified for the relevant diseases under the application) will be excluded.
¨é In case the National Health Insurance law is not applicable to the
insured(covered person), (including cases where the procedures required for
treatment fees specified under the National Health Insurance law or medical
benefits under Medical Care Assistance Act were not gone through), the
amount equal to 40% of the amount actually paid by the insured (covered
person) out of the medical expenses for hospitalization will be deemed to be
the maximum amount of the insured amount per disease (the amount
determined by the policyholder within the maximum limit of 50 million won per
injury) to be compensated.
¨ê The company will compensate for up to 365 days from the first date of
hospitalization (including the first date of hospitalization) for expenses for
hospitalization for one disease (Diseases that are acknowledged by doctors to
be medically related will be deemed to be the same disease and cases where
the same disease is treated two or more times will also be deemed to be one
disease.). However, in case the insured(covered person) is hospitalized for
longer than 365 days from the first date of hospitalization due to the same
disease, the hospitalization will be deemed to be hospitalization due to a new
disease and compensated again only when the 90-day period of exclusion
from compensation has passed as shown below
Period to be
compensated
(365days)
Exclusion from
compensation
(90days)
Period to be
compensated
(365days)
¡è
Contract date
(2010.1.1)
¡è
1st date of
hospitalization
(2010.3.1)
¡è
(2011.2.28)
Excluded from
compensation
from 2011.3.1.
¡è
(2011.5.29)
Compensation
will be resumed
from 2011.5.30
¡è
(2012.5.29)
Excluded from
compensation
from 2012.5.30
¨ë Even if the insurance period expires while the insured (covered person) is
hospitalized for treatment, the continued hospitalization will be compensated
for up to 180 days after the expiry date of the insurance period (excluding the
expiry date of the insurance period. However, item 4 will not be applied to this
case.
¨ì If the medical expenses to be paid by the insured (covered person) were
reduced by any employee welfare system of the hospital, the medical
expenses for hospitalization will be calculated based on the medical expenses
before the reduction.
¨í The same diseases refer to diseases with the same etiology (including diseases
that are medically related) and when treatments of complications that occurred
during the treatment of a disease or newly found disease are conducted
together or the patient was hospitalized with many kinds of diseases that are
not medically related, the diseases will be considered to be the same disease.
¨î Notwithstanding item 2, even if a disease was confirmed by diagnoses before
the date of application, the disease will be compensated for pursuant to this
agreement after five years have passed from the date of application if there
has been no additional diagnosis (excluding simple health examinations) or
treatment over five years after the date of application (Cases where the
contract has been automatically renewed until five years have passed are
included.).
¨ï ¡®Over five years after the date of application¡¯ under item 8 refers to cases where
the termination of the contract specified in Article 11 (Summons (Calls) in Case
of Delay in Payment and Termination of the Contract) of the general provisions
has not occurred.
¨ð When the contract has been reinstated as specified under Article 12
(Restoration (Recovery of Effect) of Contract that is Terminated Due to the
Delay in Payment) of general provisions, the date of reinstatement will be
applied as the date of application under item 8.
¨ç When the insured(covered person) received ambulatory treatments or
Ambulator
y care due
to
diseases
prescription fillings due to diseases, the company will compensate for
ambulatory treatment expenses (various ambulatory treatment expenses,
ambulatory operation expenses) and prescription filling expenses as medical
expenses for ambulatory treatments as follows based on one year from the
date of each year corresponding to the date of contract
Division
Ambulatory
treatment
Expenses
for
prescriptio
n filling
Limit of compensation
The amount of the sum of ¡®the patient¡¯s share out of the treatment fees
specified under the National Health Insurance law or medical benefits
under the Medical Care Assistance Act¡¯ and the ¡®non-payable expenses¡¯
less £¼Table 1 amounts to be deducted by item£¾ will be compensated
per visit up to the insured amount for ambulatory treatments (up to 180
visits per year from the date corresponding to the date of contract in each
year)
The amount of the sum of ¡®the patient¡¯s share out of the treatment fees
specified under the National Health Insurance law or medical benefits
under the Medical Care Assistance Act¡¯ and the ¡®non-payable expenses¡¯
less £¼Table 1 amounts to be deducted by item£¾ will be compensated
per prescription up to the insured amount for expenses for prescription
filling note) (up to 180 prescriptions per year from the date corresponding to
the date of contract in each year)
Note) Expenses for ambulatory treatments and prescription fillings shall be
determined by the policyholder within the maximum limit of the sum of
300,000 won per visit (prescription).
£¼Table 1 Amounts to be deducted by item£¾
Division
Ambulatory
treatment
(sum of
various
ambulatory
treatment
expenses
and
ambulatory
operation
expenses)
Expenses
for
prescriptio
n filling
Item
Clinics, dental clinics and Oriental medicine clinics under
paragraph 1, item 2 of Article 3 of the Medical Service
law; maternity hospitals under paragraph 2, item 2 of
Article 3 of the Medical Service law; public health centers
under Article 7 of the Regional Health law; public health
medical centers under Article 8 of the Regional Health
law; public health centers¡¯ branches under Article 10 of
the Regional Health law; public health clinics under
Article 15 of the Special Action law for the health and
medical services for agricultural or fishing villages
General hospitals, hospitals, dental hospitals, oriental
hospitals, and treatment hospitals under paragraph 3,
item 2 of Article 3 of the Medical Service law
General specialized nursing facilities under item 2 of
Article 40 of the National Health Insurance law or
Superior general hospital under Article 3-4 of Medical
Service law
Pharmacies under point 2 of item 1 of Article 40 of the
National Health Insurance law, prescriptions at the Korea
Orphan Drug Center under point 3 of item 1 of Article 40
of the said law, compounding (per prescription of a
doctor, per direct compounding by a pharmacist in
regions exceptional from the separation of dispensary
Amount to
be deducted
10,000 won
1
5,000 won
20,000 won
8,000 won
from medical practice)
¨è Even if the insurance period expires while the insured (covered person) is
receiving ambulatory treatments, the continued ambulatory treatments will be
compensated for up to 180 days after the expiry date of the insurance period
up to 90 visits for ambulatory treatments and 90 prescriptions for expenses for
prescription filling
n
Period to be
compensated
(1year)
Period to be
compensated
(1year)
Period to be
compensated
(1year)
Additional
compensatio
(180days)
¡è
Date of
contract
(2010.1.1)
¡è
Date
corresponding
to the date of
contract
¡è
Date
corresponding
to the date of
contract
¡è
Expiry date of
the insurance
period
(2012.12.31)
¡è
Ending of
compensation
(2013.6.29.)
(2011.1.1)
(2012.1.1)
¨é Two or more ambulatory treatments at a medical institution in a day due to one
disease (including two or more prescription fillings at a pharmacy due to one
disease) will be deemed to one ambulatory treatment or one prescription and
items 1 and 2 shall apply.
¨ê From the diseases set forth under item 1, the diseases corresponding to the
¡®obligation to notify before a contract¡¯ (limited to important matters) under the
application that were diagnosed or treated in the past (this refers to the period
to be notified for the relevant diseases under the application) will be excluded.
¨ë In case the National Health Insurance law or Medical Care Assistance Act is not
applicable to the insured(covered person), (including cases where the
procedures required for treatment fees specified under the National Health
Insurance law or medical benefits under Medical Care Assistance Act were not
gone through), the amount equal to 40% of the amount actually paid by the
insured (covered person) out of the ambulatory medical expenses and
expenses for prescription filling will be compensated up to the insured
amount(the amount of ambulatory medical expenses and expenses for
prescription filling per visit(prescription) determined by the policyholder within
the maximum limit of 300,000 won).
¨ì If the medical expenses to be paid by the insured (covered person) were
reduced by any employee welfare system of the hospita, or the pharmacy the
medical expenses for ambulatory treatment will be calculated based on the
medical expenses before the reduction.
¨í Notwithstanding item 4, even if a disease was confirmed by diagnoses before
the date of application, the disease will be compensated for pursuant to this
agreement after five years have passed from the date of application if there has
been no additional diagnosis (excluding simple health examinations) or
treatment over five years after the date of application (Cases where the
contract has been automatically renewed until five years have passed are
included.).
¨î ¡®Over five years after the date of application¡¯ under item 7 refers to cases where
the termination of the contract specified in Article 11 (Summons (Calls) in Case
of Delay in Payment and Termination of the Contract) of general provisions has
not occurred.
¨ï When the contract has been reinstated as specified under Article 12
(Restoration (Recovery of Effect) of Contract that is Terminated Due to the
Delay in Payment) of general provisions, the date of reinstatement will be
applied as the date of application under item 7.
General medical expenses (for injuries and
diseases) that are to be compensated out of
medical expenses in medical institutions in
Korea
Division
Cases to be compensated
¨ç When the insured (covered person) was hospitalized and treated due to injuries
or diseases, the company will compensate for the medical expenses for
hospitalization up to the insured amount per injury (the amount determined by
the policyholder within the maximum limit of 50 million won per injury and per
disease, respectively) as follows.
Division
Sickroom
charges, various
hospitalization
expenses,
hospitalized
operation
expenses
Amount
difference for
higher grade
sickrooms
Amount to be compensated
The amount equal to 90% of the sum of ¡®the patient¡¯s share out of the
treatment fees specified under the National Health Insurance law or
medical benefits under the Medical Care Assistance Act¡¯ and the
¡®non-payable expenses(excluding amount differences for higher
grade sickrooms)¡¯(However, if the amount equal to the remaining
10% exceeds 2 million won for one year from the date of contract or
each anniversary of the date of contract, the exceeding amount will
be compensated))
The amount of 50% of the amount difference between the sickroom
actually used during hospitalization and the standard sickroom
(However, the amount will be limited to the amount calculated based
on the daily average amount of 100,000 won at the maximum and the
daily average amount is to be calculated by dividing the total of the
higher grade sickroom charge for the entire hospitalization period by
the entire days of hospitalization.)
General ¨è The injuries set forth under item ¨ç include toxic symptoms resulting from toxic
hospitaliza gases or toxic substances abruptly inhaled, absorbed or taken by chance.
tion However, bacterial food poisoning and toxic symptoms resulted from habitual
inhalation, absorption or intakes are not included.
¨é From the diseases set forth under item 1, the diseases corresponding to the
¡®obligation to notify before a contract¡¯ (limited to important matters) under the
application that were diagnosed or treated in the past (this refers to the period
to be notified for the relevant diseases under the application) will be excluded.
¨ê In case the National Health Insurance law or Medical Service Assistance Act is
not applicable to the insured(covered person), (including cases where the
procedures required for treatment fees specified under the National Health
Insurance law or medical benefits under Medical Care Assistance Act were not
gone through), the amount equal to 40% of the amount actually paid by the
insured (covered person) will be deemed to be the maximum amount of the
insured amount per injury (the amount determined by the policyholder within the
maximum limit of 50 million won per injury and per disease, respectively.) to be
compensated
¨ë The company will compensate for up to 365 days from the first date of
hospitalization (including the first date of hospitalization) for expenses for
hospitalization for one injury (Cases where the same injury is treated two or
more times will also be deemed to be one injury.) or for one disease (Diseases
that are acknowledged by doctors to be medically related will be deemed to be
the same disease and cases where the same disease is treated two or more
times will also be deemed to be one disease.). However, in case the
insured(covered person), is hospitalized for longer than 365 days from the first
date of hospitalization, the injury or disease will be deemed to be a new injury
or disease and compensated again only when the 90-day period of exclusion
from compensation has passed as shown below.
Period to be
compensated
(365days)
Exclusion from
compensation
(90days)
Period to be
compensated
(365days)
¡è
Contract date
(2010.1.1)
¡è
1st date of
hospitalization
(2010.3.1)
¡è
(2011.2.28)
Excluded from
compensation
from 2011.3.1.
¡è
(2011.5.29)
Compensation
will be resumed
from
¡è
(2012.5.29)
Excluded from
compensation
from 2012.5.30
2011.5.30.
¨ì Even if the insurance period expires while the insured (covered person) is
hospitalized for treatment, the continued hospitalization will be compensated
for up to 180 days after the expiry date of the insurance period (excluding the
expiry date of the insurance period. However, item 5 will not be applied to this
case.
¨í If the medical expenses to be paid by the insured (covered person) were
reduced by any employee welfare system of the hospital, the medical
expenses for hospitalization will be calculated based on the medical expenses
before the reduction.
¨î The same diseases refer to diseases with the same etiology (including diseases
that are medically related) and when treatments of complications occurred
during the treatment of a disease or newly found disease are conducted
together or the patient was hospitalized with many kinds of diseases that are
not medically related, the diseases will be considered to be the same disease.
¨ï Notwithstanding item 3, even if a disease was confirmed by diagnoses before
the date of application, the disease will be compensated for pursuant to this
agreement after five years have passed from the date of application if there has
been no additional diagnosis (excluding simple health examinations) or
treatment over five years after the date of application (Cases where the
contract has been automatically renewed until five years have passed are
included.).
¨ð ¡®Over five years after the date of application¡¯ under item 9 refers to cases where
the termination of the contract specified in Article 15 (Summons (Calls) in Case
of Delay in Payment and Termination of the Contract) of general provisions has
not occurred.
¨ñ When the contract has been reinstated as specified under Article 16
(Restoration (Recovery of Effect) of Contract that is Terminated Due to the
Delay in Payment) of general provisions, the date of reinstatement will be
applied as the date of application under item 9.
General ¨ç When the insured(covered person) received ambulatory treatments or
ambulator
y care
prescription fillings due to injuries or diseases, the company will compensate
for ambulatory treatment expenses (various ambulatory treatment expenses,
ambulatory operation expenses) and prescription filling expenses as medical
expenses for ambulatory treatments as follows based on one year from the
date of each year corresponding to the date of contract
Division
Ambulatory
treatment
Expenses
for
prescription
filling
Limit of compensation
The amount of the sum of ¡®the patient¡¯s share out of the treatment fees
specified under the National Health Insurance law or medical benefits
under the Medical Care Assistance Act¡¯ and the ¡®non-payable expenses¡¯
less £¼Table 1 amounts to be deducted by item£¾ will be compensated
per visit up to the insured amount for ambulatory treatments note) (up to
180 visits per year from the date corresponding to the date of contract in
each year)
The amount of the sum of ¡®the patient¡¯s share out of the treatment fees
specified under the National Health Insurance law or medical benefits
under the Medical Care Assistance Act¡¯ and the ¡®non-payable expenses¡¯
less £¼Table 1 amounts to be deducted by item£¾ will be compensated
per prescription up to the insured amount for expenses for prescription
filling note) (up to 180 prescriptions per year from the date corresponding
to the date of contract in each year)
Note) Expenses for ambulatory treatments and prescription fillings shall be
determined by the policyholder within the maximum limit of the sum of
300,000 won per visit (prescription).
£¼Table 1 Amounts to be deducted by item£¾
Division
Ambulatory
treatment
(sum of various
ambulatory
treatment
expenses and
ambulatory
operation
expenses)
Expenses
for prescription
filling
Item
Clinics, dental clinics and Oriental medicine clinics
under paragraph 1, item 2 of Article 3 of the Medical
Service law; maternity hospitals under paragraph 2,
item 2 of Article 3 of the Medical Service law; public
health centers under Article 7 of the Regional Health
law; public health medical centers under Article 8 of
the Regional Health law; public health centers¡¯
branches under Article 10 of the Regional Health law;
public health clinics under Article 15 of the Special
Action law for the health and medical services for
agricultural or fishing villages
General hospitals, hospitals, dental hospitals, oriental
hospitals, and treatment hospitals under paragraph 3,
item 2 of Article 3 of the Medical Service law
General specialized nursing facilities under item 2 of
Article 40 of the National Health Insurance law or
Superior general hospital under Article 3-4 of Medical
Service law
Pharmacies under point 2 of item 1 of Article 40 of the
National Health Insurance law, prescriptions at the
Korea Orphan Drug Center under point 3 of item 1 of
Article 40 of the said law, compounding (per
prescription of a doctor, per direct compounding by a
pharmacist in regions exceptional from the separation
of dispensary from medical practice)
Amount to
be deducted
10,000 won
15,000
won
20,000 won
8,000 won
¨è The injuries set forth under item ¨ç include toxic symptoms resulting from toxic
gases or toxic substances abruptly inhaled, absorbed or taken by chance.
However, bacterial food poisoning and toxic symptoms resulted from habitual
inhalation, absorption or intakes are not included.
¨é From the diseases set forth under item 1, the diseases corresponding to the
¡®obligation to notify before a contract¡¯ (limited to important matters) under the
application that were diagnosed or treated in the past (this refers to the period
to be notified for the relevant diseases under the application) will be excluded.
¨ê In case the National Health Insurance law or Medical Care Assistance Act is
not applicable to the insured(covered person), (including cases where the
procedures required for treatment fees specified under the National Health
Insurance law or medical benefits under Medical Care Assistance Act were not
gone through), the amount equal to 40% of the amount actually paid by the
insured (covered person) out of the ambulatory medical expenses less the
up to the insured amount(the
amount of ambulatory medical expenses and expenses for prescription filling
per visit(prescription) determined by the policyholder within the maximum limit
of 300,000 won).
¨ë Even if the insurance period expires while the insured (covered person) is
receiving ambulatory treatments, the continued ambulatory treatments will be
compensated for up to 180 days after the expiry date of the insurance period
up to 90 visits for ambulatory treatments and 90 prescriptions for expenses for
prescription filling.
n
Period to be
compensated
(1year)
Period to be
compensated
(1year)
Period to be
compensated
(1year)
Additional
compensatio
(180days)
¡è
Date of
contract
(2010.1 1)
¡è
Date
corresponding to
the date of
¡è
Date
corresponding
to the date of
¡è
Expiry date of the
insurance period
(2012.12.31)
¡è
Ending of
compensation
(2013.6.29.)
contract
(2011.1.1)
contract
(2012.1.1)
¨ì Two or more ambulatory treatments at a medical institution in a day due to one
injury (including two or more prescription fillings at a pharmacy due to one
injury) will be deemed to be one ambulatory treatment or one prescription and
items 1 and 5 shall apply.
¨í If the medical expenses to be paid by the insured (covered person) were
reduced by any employee welfare system of the hospital or pharmacy, the
medical expenses for amburatory treatment will be calculated based on the
medical expenses before the reduction.
¨î Notwithstanding item 3, even if a disease was confirmed by diagnoses before
the date of application, the disease will be compensated for pursuant to this
agreement after five years have passed from the date of application if there
has been no additional diagnosis (excluding simple health examinations) or
treatment over five years after the date of application (Cases where the
contract has been automatically renewed until five years have passed are
included.).
¨ï ¡®Over five years after the date of application¡¯ under item 8 refers to cases where
the termination of the contract specified in Article 11 (Summons (Calls) in Case
of Delay in Payment and Termination of the Contract) of the general provisions
has not occurred
¨ð When the contract has been reinstated as specified under Article 12
(Restoration (Recovery of Effect) of Contract that is Terminated Due to the
Delay in Payment) of general provisions, the date of reinstatement will be
applied as the date of application under item 8
Medical expenses for injuries that are not to be
compensated out of medical expenses in medical
institutions in Korea
Division
Hospitaliz
ation due
to injuries
Cases not to be compensated for
¨ç The company will not compensate for medical expenses for hospitalization
arising from following causes.
1. Beneficiary¡¯s intention. However, if the beneficiary is one of multiple
beneficiaries of the insurance money, the remaining insurance money
excluding the insurance money corresponding to the beneficiary will be paid
to other beneficiaries.
2. Policyholder¡¯s intention
3. Intention of the insured (covered person). However, if the fact that the insured
(covered person) injured himself/herself in a condition of being unable to
make free decisions because he/she was non compos mentis has been
proved, the relevant expenses will be compensated for.
4. Cases where the insured (covered person) was hospitalized due to
pregnancy, parturition (including cesarean section) or puerperium. However,
treatments for the kinds of injuries specified to be compensated for by the
company will be compensated for.
5. War, foreign country¡¯s use of armed force, revolution, insurrection, incident,
riot
6. In case the insured (covered person) did not follow doctor¡¯s instructions
during the period of hospitalization without any justifiable reason, the
company will not compensate for the expenses for the portion deteriorated
due to the foregoing.
¨è Unless agreed to otherwise, the company will not compensate for injuries
resulting from any of the acts listed below conducted by the insured(covered
person) for the sake of his/her occupation, duty or club activity:
1. Professional climbing (refers to climbing rock walls or ice ridges using special
climbing equipment or those kinds of climbing that require special skills,
experience and prior training), gliding, skydiving, scuba diving and hang-
gliding
2. Competitions, demonstrations or entertainment using motor boats, cars or
motorcycles (including practices for these) or test runs (however, injuries
suffered during test runs on public roads will be compensated for)
3. Onboard a ship as a profession, e.g., crewmember, fisherman, boatman, etc.
¨é The company will not compensate for any of the medical expenses listed
below:
1. Uncovered medical expenses arising from dental treatments or Korean
medicinal treatments that do not fall under the treatment fees under the
National Health Insurance Act
2. In the case of patients¡¯ shares of the treatment fees under the National Health
Insurance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share limit
system).
3. In the case of patient¡¯s share out of the medical benefits under the Medical
Care Assistance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share
compensation system or patient¡¯s share limit system under Medical Care
Assistance Act)
4. Medical expenses for health inspections, vaccinations or induced abortions
However, if the treatments are for the purpose of treating injuries, they will be
compensated for.
5. Expenses spent for administration of nutrients, multiple vitamins, hormones or
tonic medicines, diagnoses for paternity identifications, infertility inspections,
sterilizations, restorations from sterility, assisted reproductive operations
(including internal fecundations and external fecundations) or growth
promotion. However, if the treatments are for the purpose of treating injuries,
they will be compensated for.
6. Expenses to buy or replace treatment materials such as abutments, artificial
hands or legs, artificial eyes, glasses, contact lenses, hearing aids, crutches,
arm slings or aids (However, items that are implanted in the body to replace
organs such as artificial organs or partial dentures are exceptional.)
7. Medical expenses arising from treatments for the purpose of improvements of
outward appearance.
a. Double eyelid formation, rhinoplasty(augmentation rhinoplasty), breast
augmentation/reduction, suction lipectomy, rhitidectomy, etc.
b. Visual system operations for improvements of outward appearance but not
for improvements of eyesight such as revisions of tropia or orbital
hypertelorism
c. Orthoptics to replace glasses or contact lenses
d. Leg varix operations for the purpose of improvements of outward app
earance
8. All other expenses not related to treatments (TV subscription fees, telephone
charges, various certificate fees etc), inspection expenses not related to
doctors¡¯ clinical findings
9. Medical expenses to be compensated by car insurance (including fraternal
insurance) or industrial disaster insurance. However, the patient¡¯s share of
the medical expenses will be compensated pursuant to Article 3(Cases
compensated for by covered item).
10. Medical expenses that occurred in medical institutions located overseas
which are not the treatment institutions under Article 40 of the National
Health Insurance law.
¨ç The company will not compensate for medical expenses for ambulatory
treatments arising from the following causes.
1. Beneficiary¡¯s intention. However, if the beneficiary is one of multiple
beneficiaries of the insurance money, the remaining insurance money
excluding the insurance money corresponding to the beneficiary will be paid
to other beneficiaries.
2. Policyholder¡¯s intention
3. Intention of the insured (covered person). However, if the fact that the
insured (covered person) injured himself/herself in a condition of being
unable to make free decisions because he/she was non compos mentis has
Ambulator
y care due
to injuries
been proved, the relevant expenses will be compensated for.
4. Cases where the insured (covered person) was treated due to pregnancy,
parturition (including caesarian section) or puerperium. However, treatments
for the kinds of injuries specified to be compensated for by the company will
be compensated for.
5. War, foreign country¡¯s use of armed force, revolution, insurrection, incident,
riot
6. In case the insured (covered person) did not follow doctor¡¯s instructions
during the period of receiving ambulatory treatments without any justifiable
reason, the company will not compensate for the expenses for the portion
deteriorated due to the foregoing.
¨è Unless agreed to otherwise, the company will not compensate for injuries
resulting from any of the acts listed below conducted by the insured(covered
person) for the sake of his/her occupation, duty or club activity:
1. Professional climbing (refers to climbing rock walls or ice ridges using special
climbing equipment or those kinds of climbing that require special skills,
experience and prior training), gliding, skydiving, scuba diving and hang-
gliding
2. Competitions, demonstrations or entertainment using motor boats, cars or
motorcycles (including practices for these) or test runs (however, injuries
suffered during test runs on public roads will be compensated for)
3. Onboard a ship as a profession, e.g., crewmember, fisherman, boatman, etc.
¨é The company will not compensate for any of the ambulatory medical expenses
listed below:
1. Uncovered medical expenses arising from dental treatments or Korean
medicinal treatments that do not fall under the treatment fees under the
National Health Insurance Act
2. In the case of patients¡¯ shares of the treatment fees under the National Health
Insurance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share limit
system).
3. In the case of patient¡¯s share out of the medical benefits under the Medical
Care Assistance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share
compensation system or patient¡¯s share limit system under Medical Care
Assistance Act)
4. Medical expenses for health inspections, vaccinations or induced abortions.
However, if the treatments are for the purpose of treating injuries, they will be
compensated for.
5. Expenses spent for administration of nutrients, multiple vitamins, hormones or
tonic medicines, diagnoses for paternity identifications, infertility inspections,
sterilizations, restorations from sterility, assisted reproductive operations
(including internal fecundations and external fecundations) or growth
promotion. However, if the treatments are for the purpose of treating injuries,
they will be compensated for.
6. Expenses to buy or replace treatment materials such as abutments, artificial
hands or legs, artificial eyes, glasses, contact lenses, hearing aids, crutches,
arm slings or aids (However, items that are implanted in the body to replace
organs such as artificial organs or partial dentures are exceptional.)
7. Medical expenses arising from treatments for the purpose of improvements of
outward appearance.
a. Double eyelid formation, rhinoplasty(augmentation rhinoplasty), breast
augmentation/reduction, suction lipectomy, rhitidectomy, etc.
b. Visual system operations for improvements of outward appearance but not
for improvements of eyesight such as revisions of tropia or orbital
hypertelorism
c. Orthoptics to replace glasses or contact lenses
d. Leg varix operations for the purpose of improvements of outward
appearance
8. All other expenses not related to treatments (TV subscription fees, telephone
charges, various certificate fees etc), inspection expenses not related to
doctors¡¯ clinical findings
9. Medical expenses to be compensated by car insurance (including fraternal
insurance) or industrial disaster insurance. However, the patient¡¯s share of the
medical expenses will be compensated pursuant to Article 3(Cases
compensated for by covered item).
10. Medical expenses that occurred in medical institutions located overseas
which are not the treatment institutions under Article 40 of the National
Health Insurance law
Medical expenses for diseases that are not to be
compensated out of medical expenses in medical
institutions in Korea
Division
Hospitaliz
ation due
to
diseases
Cases not to be compensated for
¨ç The company will not compensate for medical expenses for hospitalization
arising from following causes.
1. Beneficiary¡¯s intention. However, if the beneficiary is one of multiple
beneficiaries of the insurance money, the remaining insurance money
excluding the insurance money corresponding to the beneficiary will be paid
to other beneficiaries.
2. Policyholder¡¯s intention
3. Intention of the insured (covered person). However, if the fact that the insured
(covered person) injured himself/herself in a condition of being unable to
make free decisions because he/she was non compos mentis has been
proved, the relevant expenses will be compensated for.
4. In case the insured (covered person) did not follow doctor¡¯s instructions
during the period of hospitalization without any justifiable reason, the
company will not compensate for the expenses for the portion deteriorated
due to the foregoing.
¨è The company will not compensate for the following medical expenses for
hospitalization set forth under the 5 th Korea Standard Disease Cause
Classification.
1. Psychiatric disorders and behavior disorders (F04~F99)
2. Habitual abortions due to non-inflammatory disorders of female genital organs,
infertility or artificial fertilization related complications(N96~N98)
3. Hospitalization of the insured (covered person) due to pregnancy, parturition
(including cesarean sections) or puerperium (O00~O99)
4. Congenital brain diseases (Q00~Q04)
5. Obesity (E66)
6. Urinary system disorders (N39, R32)
7. Some of rectal or anal diseases that do not correspond to the treatment fees
under the National Health Insurance Act (I84, K60~K62)
¨é The company will not compensate for any of the medical expenses listed below:
1. Uncovered medical expenses arising from dental treatments or Korean
medicinal treatments that do not fall under the treatment fees under the
National Health Insurance Act
2. In the case of patients¡¯ shares of the treatment fees under the National Health
Insurance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share limit
system).
3. In the case of patient¡¯s share out of the medical benefits under the Medical
Care Assistance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share
compensation system or patient¡¯s share limit system under Medical Care
Assistance Act)
4. Medical expenses for health inspections, vaccinations or induced abortions.
However, if the treatments are for the purpose of treating diseases, they will
be compensated for.
5. Expenses spent for administration of nutrients, multiple vitamins, hormones or
tonic medicines, diagnoses for paternity identifications, infertility inspections,
sterilizations, restorations from sterility, assisted reproductive operations
(including internal fecundations and external fecundations) or growth
promotion. However, if the treatments are for the purpose of treating
diseases, they will be compensated for.
6. Medical expenses arising from any of the treatments listed below:
a. Simple fatigue or malaise
b. Freckle, hirsutism, atrichia, poliosis, rosacea, nevus, wart, acne, cutan eous
disorders due to aging effects such as alopecia
c. Impotence, sex frigidity, simple snore, simple phimosis, ophthalmic disease
(e.g. Pinguecula) that does not affect work or daily life pursuant to item 1 of
Article 9 ([Schedule 2] nonpayment items) in the provisions for criteria of
treatment fee payment under National Health Insurance
7. Expenses to buy or replace treatment materials such as abutments, artificial
hands or legs, artificial eyes, glasses, contact lenses, hearing aids, crutches,
arm slings or aids (However, items that are implanted in the body to replace
organs such as artificial organs or partial dentures are exceptional.)
8. Medical expenses arising from treatments for the purpose of improvements of
outward appearance.
a. Double eyelid formation, rhinoplasty(augmentation rhinoplasty), breast aug
men tation/reduction, suction lipectomy, rhitidectomy, etc.
b. Visual system operations for improvements of outward appearance but not
for improvements of eyesight such as revisions of tropia or orbital
hypertelorism
c. Orthoptics to replace glasses or contact lenses
d. Leg varix operations for the purpose of improvements of outward appe
arance
9. All other expenses not related to treatments (TV subscription fees, telephone
charges, various certificate fees etc), inspection expenses not related to
doctors¡¯ clinical findings
10. Medical expenses to be compensated by industrial disaster insurance.
However, the patient¡¯s share of the medical expenses will be compensated
pursuant to Article 3(Cases compensated for by covered item).
11. Treatment expenses due to human immunodeficiency virus (HIV) infection
(However, cases objectively confirmed through relevant treatment records
where medical workers were infected with HIV through blood during
treatments will be excluded)
12. Medical expenses that occurred in medical institutions located overseas
which are not the treatment institutions under Article 40 of the National
Health Insurance law.
¨ç The company will not compensate for medical expenses for ambulatory
treatments arising from the following causes.
1. Beneficiary¡¯s intention. However, if the beneficiary is one of multiple
beneficiaries of the insurance money, the remaining insurance money
excluding the insurance money corresponding to the beneficiary will be paid
to other beneficiaries.
2. Policyholder¡¯s intention
Ambulator 3. Intention of the insured (covered person). However, if the fact that the insured
to
y care due
diseases
(covered person) injured himself/herself in a condition of being unable to make
free decisions because he/she was non compos mentis has been proved, the
relevant expenses will be compensated for.
4. In case the insured (covered person) did not follow doctor¡¯s instructions during
the period of receiving ambulatory treatments without any justifiable reason,
the company will not compensate for the expenses for the portion deteriorated
due to the foregoing.
¨è The company will not compensate for any of the following ambulatory medical
expenses set forth under the 5 th Korea Standard Disease Cause Classification.
1. Psychiatric disorders and behavior disorders (F04~F99)
2. Habitual abortions due to non-inflammatory disorders of female genital organs,
infertility or artificial fertilization related complications(N96~N98)
3. Ambulatory treatments of the insured (covered person) due to pregnancy,
parturition (including cesarean sections) or puerperium (O00~O99)
4. Congenital brain diseases (Q00~Q04)
5. Obesity (E66)
6. Urinary system disorders (N39, R32)
7. Some of rectal or anal diseases that do not correspond to the treatment fees
under the National Health Insurance Act (I84, K60~K62)
¨é The company will not compensate for any of the ambulatory medical expenses
listed below:
1. Uncovered medical expenses arising from dental treatments or Korean
medicinal treatments that do not fall under the treatment fees under the
National Health Insurance Act
2. In the case of patients¡¯ shares of the treatment fees under the National Health
Insurance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share limit
system).
3. In the case of patient¡¯s share out of the medical benefits under the Medical
Care Assistance Act, the amount that can be refunded by the National Health
Insurance Corporation prior to or after the payment (patient¡¯s share
compensation system or patient¡¯s share limit system under Medical Care
Assistance Act)
4. Medical expenses for health inspections, vaccinations or induced abortions.
However, if the treatments are for the purpose of treating diseases, they will be
compensated for.
5. Expenses spent for administration of nutrients, multiple vitamins, hormones or
tonic medicines, diagnoses for paternity identifications, infertility inspections,
sterilizations, restorations from sterility, assisted reproductive operations
(including internal fecundations and external fecundations) or growth
promotion. However, if the treatments are for the purpose of treating diseases,
they will be compensated for.
6. Medical expenses arising from any of the treatments listed below:
a. Simple fatigue or malaise
b. Freckle, hirsutism, atrichia, poliosis, rosacea, nevus, wart, acne, cutaneous
disorders due to aging effects such as alopecia
c. Impotence, sex frigidity, simple snore, simple phimosis, ophthalmic disease
(e.g. Pinguecula) that does not affect work or daily life pursuant to item 1 of
Article 9 ([Schedule 2] nonpayment items) in the provisions for criteria of
treatment fee payment under National Health Insurance
7. Expenses to buy or replace treatment materials such as abutments, artificial
hands or legs, artificial eyes, glasses, contact lenses, hearing aids, crutches,
arm slings or aids (However, items that are implanted in the body to replace
organs such as artificial organs or partial dentures are exceptional.)
8. Medical expenses arising from treatments for the purpose of improvements of
outward appearance.
a. Double eyelid formation, rhinoplasty(augmentation rhinoplasty), breast
augmentation/reduction, suction lipectomy, rhitidectomy, etc.
b. Visual system operations for improvements of outward appearance but not
for improvements of eyesight such as revisions of tropia or orbital
hypertelorism
c. Orthoptics to replace glasses or contact lenses
d. Leg varix operations for the purpose of improvements of outward appe
arance
9. All other expenses not related to treatments (TV subscription fees, telephone
charges, various certificate fees etc), inspection expenses not related to
doctors¡¯ clinical findings
10. Medical expenses to be compensated by industrial disaster insurance.
However, the patient¡¯s share of the medical expenses will be compensated
pursuant to Article 3(Cases compensated for by covered item).
11. Treatment expenses due to human immunodeficiency virus (HIV) infection
(However, cases objectively confirmed through relevant treatment records
where medical workers were infected with HIV through blood during
treatments will be excluded)
12. Medical expenses that occurred in medical institutions located overseas which
are not the treatment institutions under Article 40 of the National Health
Insurance law
Special agreement for those who are not covered by the National
Health Insurance
Article 1 (Scope of the Insured (Covered Person))
The insured (covered persons) in this additional special agreement shall be those who are not
covered by the National Health Insurance Act or Medical Care Assistance Act among the
insured (covered persons) who concluded the special agreement for insurance for actual
medical expenses.
Article 2 (Duty to Disclose after Contract Conclusion)
¨ç Once the insured (covered person) acquired the qualification specified under the National
Health Insurance Act or Medical Care Assistance Act, the contractor shall notify the
Company accordingly in writing and have it indicated in the insurance policy (insurance
certificate).
¨è When the insured (covered person) acquired the qualification specified under the National
Health Insurance Act or Medical Care Assistance Act, this special agreement shall be
terminated as of the date of occurrence of the fact. In such case, the Company shall
refund the defined insurance premium calculated based on the remaining number of days.
Article 3 (Covered Items)
Notwithstanding Article 3 (Cases compensated for by covered item) and Article 4 (Cases not
to be compensated for) of Special Agreement for Insurance for Actual Medical Expenses
during Overseas Travel, Special Agreement for Insurance for Actual Medical Expenses during
Overseas Travel shall be applied for the insured (covered person) of this Special agreement
same as those who are covered by the National Health Insurance or those who are not
covered by the Medical Care Assistance Act. Note, however, not withstanding this Special
agreement, patient¡¯s share of treatment fees of the insured (covered person) that are not
covered by car insurance (inclusive of deductions) or Industrial Accident Insurance, shall be
covered pursuant to Article 3 (Cases compensated for by covered item) and Article 4 (Cases
not to be compensated for) of Special Agreement for Insurance for Actual Medical Expenses
during Overseas Travel.
Article 4 (Application of the Provisions)
Matters other than those specified in this additional special agreement shall be determined
pursuant to the general agreement and special agreement for insurance for actual medical
expenses.
[Attachment] Disability Classification Table
¨ç General Provisions
1. Definition of disability
1) ¡°Disability¡± refers to the permanent mental or bodily damage that remains after the
injuries or diseases are cured, excluding the prevailing symptoms and complications of
diseases and injuries and temporary symptoms during the process of treatment.
2) ¡°Permanent¡± as used herein pertains to the case wherein future recovery cannot be
expected following the treatment, and mental or bodily damage is medically recognized.
3) ¡°After the cure¡± refers to the case wherein the effects of treating injuries or diseases
cannot be expected, and the symptoms are fixed.
4) For temporary disabilities occurring for a period of five years or more, if not the fixed
symptom, after the injuries are healed, the Company shall consider 20% of the relevant
disability payment rate as the temporary disability payment rate.
2. Body part
¡°Body part¡± pertains to any of the following 13 parts: ¨ç Eyes; ¨è Ears; ¨é Nose; ¨ê Chewing
or speaking function; ¨ë Appearance; ¨ì Spine (backbone); ¨í Trunk skeleton; ¨î Arms; ¨ï
Legs; ¨ð Fingers; ¨ñ Toes; ¨ò Thoracic and abdominal organs and urinogenital organs, and;
¨ó Nervous system and mental acts. Note, however, that the left and right eyes, ears, arms,
and legs are considered different parts.
3. Others
1) If one disability applies to two or more disabilities shown on the Disability Classification
Table based on the method of observation, or in case one disability in general results in
other derivative disability, only the higher payment rate of the two shall apply.
2) If two or more disabilities develop on the same body part, the payment rates shall not be
totaled; instead, the higher payment rate shall apply. Note, however, that separately
prescribed evaluation criteria for each body part shall apply, if any.
3) Brain death as medically declared, i.e., a patient has lost his/her respiratory and
heartbeat functions, relying only on devices such as the artificial pacemaker to extend
his/her life, shall not be considered in the disability evaluation.
4) The disability medical certificate shall basically include the following: ¨ç Name of disability
and time of development; ¨è Details and degree of disability; ¨é Causal sequence with
accidents and degree of involvement, and; ¨ê Future treatment problems and level of
improvement. In the case of nervous system and mental and behavioral disorders,
however, the medical report shall also indicate the following: ¨ç whether nursing is
required, and; ¨è objective opinions and details of the required nursing.
¨è Evaluation Criteria for Disability Classification
1. Disability in the eyes
a. Disability classification
Disability classification
1) When sight is lost in both eyes
Payment Rate
100
50
35
25
15
5
10
5
10
5
2) When sight is lost in one eye
3) When the corrected eyesight in one eye is 0.02 or less
4) When the corrected eyesight in one eye is 0.06 or less
5) When the corrected eyesight in one eye is 0.1 or less
6) When the corrected eyesight in one eye is 0.2 or less
7) When the eyeball of one eye shows clear movement disorder or
control disability
8) When the visual field of one eye narrows or shows hemianopsia,
visual field contraction, or scotoma
9) When the eyelid of one eye has sustained major damage
10) When the eyelid of one eye shows clear movement disorder
b. Disability evaluation criteria
1) Visual disability shall be tested using an authorized sight-testing chart.
2) ¡°Corrected eyesight¡± pertains to the sight corrected with prescription glasses (all types of
sight correction means including contact lenses).
3) ¡°When sight is lost in one eye¡± refers to the case wherein the patient is unable to
distinguish darkness (non-light perception) or is barely able to do so (light perception)
including the avulsion of the pupil of the eye.
4) The degree of eyeball movement disorder shall be evaluated at least one year after the
occurrence of external injury.
5) ¡°Significant movement disorder of the eyeball¡± pertains to the case wherein the principal
visual field of the eyeball is reduced by 1/2 of the normal range, or the front binocular
vision is hindered by diplopia (i.e., an object looks as though it is actually composed of
two entities or is overlapped).
6) ¡°Major control function disorder of the eyeball¡± pertains to the case wherein the control
ability deteriorated by 1/2 of the normal range. If the patient is 45 years or older, however,
control ability is disregarded.
7) ¡°Visual field has narrowed¡± refers to the case wherein the sum of the visual angle is 60%
or less of the normal visual field.
8) ¡°When the eyelid has sustained major damage¡± pertains to the case wherein the cornea (black
of the eye) is not completely covered when the eyes are closed due to damage to the eyelid.
9) ¡°When the eyelid shows significant movement disorder¡± refers to the case wherein the
pupil of the eye is covered by 1/2 or more when the eyes are opened, or the cornea
cannot be fully covered when the eyes are closed.
10) If the avulsion of the pupil of the eye is unavoidable owing to external injuries or burns,
the unsightly appearance of the external view is added. In such case, if an artificial eye
cannot be inserted because of the tissue depression of the fringe of the eye following the
avulsion of the pupil of the eye, the payment rate shall consider ¡°Highly unsightly
appearance.¡± If an artificial eye can be inserted, however, "Slightly unsightly appearance"
shall be considered.
11) When the patient falls under the category ¡°When the eyelid is significantly damaged,¡± the
unsightly appearance shall not be added since it is already included in the evaluated disability.
Based on the two methods of evaluating the unsightly facial appearance, however, the one that
is more advantageous to the Insured (Covered Person) shall apply.
2. Disability in the ears
a. Disability classification
80
45
25
15
5
Disability classification
1) When hearing is lost in both ears
2) When one ear has completely lost its hearing, whereas the
hearing in the other ear has seriously deteriorated
3) When one ear has completely lost its hearing
4) When the hearing in one ear has seriously deteriorated
5) When the hearing in one ear has slightly deteriorated
Payment Rate
6) When most of the pinna of one ear has been damaged
b. Disability evaluation criteria
1) Hearing disability shall be expressed in dB (decibel) based on the results of pure tone
audiometry. The test shall be conducted at least thrice, and the results, evaluated based
on the speech reception threshold (SRT).
2) ¡°When one ear has completely lost its hearing¡± pertains to the case wherein the pure
tone average obtained based on pure tone audiometry is 90dB or higher.
3) ¡°Has sustained serious damage¡± refers to the case wherein the pure tone average is
80dB or higher based on the results of pure tone audiometry, and the patient is unable
to understand loud speech unless the speaker puts his/her mouth close to the ears of
the patient.
4) ¡°Has sustained mild damage¡± pertains to the case wherein the pure tone average is
70dB or higher based on the results of pure tone audiometry, and the patient is unable
to understand normal speech at a distance of 50cm or more.
5) In case it is difficult to perform pure tone audiometry, or if the test results require
verification, ¡°speech audiometry, impedance audiometry, auditory brainstem response
(ABR), automatic (Bekesy) audiometry, and otoacoustic emission (OAE) tests¡± shall also
be conducted to evaluate the disability.
c. Damage to pinna
1) ¡°When most of the pinna of one ear has been damaged¡± refers to the case wherein 1/2
or more of the pinna cartilage has been damaged. If the pinna damage is less than 1/2,
and in the absence of a functional problem, the case shall be classified as unsightly
appearance.
3. Disability in the nose
a. Disability classification
15
Disability classification
1) When the nose has completely lost its
olfactory function
b. Disability evaluation criteria
1) "When the nose has completely lost its olfactory function" refers to the case wherein the
patient has difficulty breathing through both nostrils, he/she has lost the olfactory
function of both nostrils completely, and hyposmia is not regarded as a disability.
2) The unsightly appearance of the nose shall be covered by adding the case to the
functional disability.
4. Chewing or speaking disability
a. Disability classification
Disability classification
Payment Rate
100
80
40
20
10
5
20
10
5
1) When both the chewing and speaking functions have seriously
deteriorated
2) When either the chewing or speaking function has seriously
deteriorated
3) When both the chewing and speaking functions have significantly
deteriorated
4) When either the chewing or speaking function has significantly
deteriorated
5) When both the chewing and speaking functions have slightly
deteriorated
6) When either the chewing or speaking function has slightly
deteriorated
7) When 14 or more teeth are lost
8) When 7 or more teeth are lost
9) When 5 or more teeth are lost
b. Disability evaluation criteria
1) Chewing disability shall be decided by comprehensively evaluating the occlusion and alignment
of the upper and lower teeth, movement of the lower jaw, and swallowing movement.
2) ¡°Chewing function seriously deteriorating¡± pertains to the case wherein the patient
cannot take in anything other than water or other drinks.
3) ¡°Chewing function significantly deteriorating¡± refers to the case wherein the patient cannot
eat anything other than thin gruel or other equivalent food (e.g., porridge).
4) ¡°Chewing function slightly deteriorating¡± pertains to the case wherein the chewing and
crushing functions are restricted even though the patient can eat some solid foods (e.g.,
cooked rice or bread).
5) ¡°Speaking function significantly deteriorating¡± refers to the case wherein the patient
cannot produce at least three of the following sounds:
¨ç Labial sound (¤±,¤²,¤½)
¨è Dental sound (¤¤,¤§, ¤©)
¨é Palatal sound (¤¡,¤¸,¤º
¨ê Guttural sound (¤·, ¤¾)
6) ¡°Speaking function significantly deteriorating¡± pertains to the case wherein the patient
cannot produce two or more of the four sounds specified in item 5) above.
7) ¡°Speaking function slightly deteriorating¡± refers to the case wherein the patient cannot
produce one of the four sounds specified in item 5) above.
8) Even aphasia due to the damaged speech center of the brain shall be regarded as a
speaking function disability.
9) ¡°Teeth loss¡± pertains to the case wherein teeth are lost, the nerves of the teeth have
been destroyed, or 1/3 or more of a tooth is fractured.
10) The teeth involving abutment crown or clasp that supports dental prosthesis like plate
denture or dental bridge, or those undergoing only post and inlay shall not be
considered lost teeth.
11) In case new teeth are lost either due to large lost teeth or due to a problem of inter-
teeth intervals or teeth alignment, the payment rate shall be decided based on the
number of teeth lost due to the accident.
12) Teeth that can be grown anew such as the milk teeth of children shall not be regarded
as an object of disability.
13) Damage to a denture that can be mounted on or dismounted from a body part shall not
be regarded as an object of disability.
5. Unsightly appearance
a. Disability classification
Disability classification
Payment Rate
15
5
1) In case highly unsightly appearance becomes permanent
2) In case slightly unsightly appearance becomes permanent
b. Disability evaluation criteria
1) ¡°Appearance¡± refers to the face (including the eyes, nose, ears, and mouth), head, and
neck.
2) ¡°Unsightly appearance¡± pertains to the unsightly appearance that becomes permanent
even after plastic surgeries have been performed, except in cases wherein the scar can
be minimized through reconstructive surgeries.
3) ¡°In case unsightly appearance becomes permanent¡± refers to the case wherein the
unsightly appearance becomes permanent even after plastic surgeries have been
performed, e.g., skin discoloration, hair loss, and tissue loss or depression (bone, skin,
etc.) due to traces of injuries or burns.
c. Highly unsightly appearance
1) Face
¨ç Unsightly appearance covering an area that is 1/2 or larger of the palm size
¨è Ugly scar (appearance/head or facial side) measuring 10 cm or more
¨é Tissue depression with diameter of 5cm or more
¨ê Reduction of nose area by 1/2 or more
2) Head
¨ç Trace of injury (scar) covering an area that is the same as or larger than the palm
size and hair loss
¨è Damage to or loss of the head bone covering an area equivalent to or larger than the
palm size
3) Neck
Unsightly appearance covering an area that is equal to or larger than the palm size
d. Slightly unsightly appearance
1) Face
¨ç Unsightly appearance covering an area that is 1/4 or larger of the palm size
¨è Ugly scar (appearance/head or facial side) measuring 5cm or more
¨é Tissue depression with diameter of 2cm or more
¨ê Reduction of nose area by 1/4 or more
2) Head
¨ç Trace of injury (scar) covering an area that is the same as or larger than 1/2 of the
palm size and hair loss
¨è Damage to or loss of the head bone covering an area equivalent to or larger than 1/2
of the palm size
3) Neck
Unsightly appearance covering an area that is 1/2 or larger of the palm size
e. Palm size
¡°Palm size¡± refers to the size of the palm of the hand of the patient excluding the fingers. In
general, the size of the palm shall be 8¡¿10 §¯ (1/2 size: 40 §²; 1/4 size: 20 §²) for persons
aged 12 years or older, 6¡¿8 §¯ (1/2 size: 24 §² and 1/4 size: 12 §²) for persons aged 6~ 11
years, and 4¡¿6 §¯ (1/2 size: 12 §², and 1/4 size: 6 §²) for persons aged 5 years or younger.
6. Spinal (backbone) disability
a. Disability classification
Disability classification
Payment Rate
40
30
10
50
30
15
20
15
10
1) When serious movement disability persists in the spine (backbone)
2) When significant movement disability persists in the spine
(backbone)
3) When slight movement disability persists in the spine (backbone)
4) When serious deformities persist in the spine (backbone)
5) When significant deformities persist in the spine (backbone)
6) When slight deformities persist in the spine (backbone)
7) Serious intervertebral disc hernia
8) Significant intervertebral disc hernia
9) Slight intervertebral disc hernia
b. Disability evaluation criteria
1) The spine (backbone) from the cervical vertebral (neck bone) and below shall be
considered a single part.
2) Serious movement disability
The case wherein four or more spinal bodies (spinal bone body) have been fused or
fixed due to fracture or dislocation
3) Significant movement disability
¨ç A case wherein three spinal bodies (spinal bone body) have been fused or fixed due
to fracture or dislocation
¨è A case wherein major dislocation occurs between the head bone and upper cervical
vertebrae (upper neck bone: 1 st and 2 nd neck bone)
4) Slight movement disability
The case wherein two spinal bodies (spinal bone body) have been fused or fixed due to
fracture or dislocation.
5) Serious deformities
Cases wherein the fracture or dislocation of the spine results in deformities such as
lordosis and kyphosis (symptom wherein the spine is bent backward) at a bending angle
of 35¡Æ or more, or scoliosis (symptom wherein the spine is bent sideways) at a bending
angle of 20¡Æ or more.
6) Significant deformities
Cases wherein the fracture or dislocation of the spine results in deformities such as
lordosis and kyphosis (symptom wherein the spine is bent backward) at a bending angle
of 15¡Æ or more, or scoliosis (symptom wherein the spine is bent sideways) at a bending
angle of 10¡Æ or more
7) Slight deformities
Cases wherein one or more of spinal fractures or dislocations result in deformities such
as mild lordosis and kyphosis (symptom wherein the spine is bent backward) or
scoliosis (symptom wherein the spine is bent sideways)
8) Serious intervertebral disc hernia
The case wherein two or more segments of the intervertebral disc are operated due to
the prolapse of the intervertebral disc or one disc is operated at least twice, resulting in
the development of the cauda equina syndrome and significant leg paralysis or
excrement/urination disorder
9) Significant intervertebral disc hernia
The case wherein major nerve symptoms are detected after one segment of the disc is
operated, results of special supplementary tests show abnormalities, and incomplete
paralysis of the spinal nerve root is noted
10) Slight intervertebral disc hernia
The case wherein the results of the special tests (e.g., computerized tomography (CT)
and magnetic resonance imaging (MRI)) show disc lesion, radicular pain in one or both
legs (pain spreading to the adjacent part of the body), or sensory disorder
11) A patient diagnosed with intervertebral disc hernia shall not be evaluated to have
movement disability or deformities regardless of the surgery performed.
7. Disability in the trunk skeleton
a. Disability classification
Disability classification
Payment Rate
15
10
1) When significant deformities persist in the scapula (shoulder
bone) or pelvis (hip bone)
2) When significant deformities persist in the clavicle (collar
bone), sternum (breast bone), and/or ribs
b. Disability evaluation criteria
1) ¡°Trunk skeleton¡± pertains to the scapula, pelvis, clavicle, sternum, and ribs.
2) "Significant deformities of the hip bone¡± refer to the following cases:
¨ç A case wherein either the sacroiliac joint or pubic anastomotic part is cured with its
separate state or the hip bone is malunioned by more than 2.5cm or more, or a pelvic
malformation occurs at a level that may hinder normal childbirth in case of women
¨è Malformation (including damage) that can clearly be recognized when the patient is
naked, and each malformation is 20¡Æ or more when measured through x-ray tests
3) ¡°When significant deformities persist in the collar bone, breast bone, ribs and/or shoulder
bone ¡° refer to the level at which malformation (including damage) can clearly be
recognized when the patient is naked; each malformation is 20¡Æ or more as measured
through x-ray tests.
4) All deformities in the ribs shall be regarded as a single disability regardless of the
number and degree of deformities or affected part.
8. Disability in the arms
a. Disability classification
Disability classification
Payment Rate
100
60
30
20
10
5
20
10
5
1) When both arms above the wrists are severed
2) When one arm above the wrist is severed
3) When one out of the three major joints of one arm has
completely lost its function
4) When serious disability persists in one out of the three major
joints of one arm
5) When significant disability persists in one out of the three major
joints of one arm
6) When slight disability persists in one out of the three major
joints of one arm
7) When the pseudarthrosis remains on one arm and leaves major
damage
8) When the pseudarthrosis remains on one arm and leaves mild
damage
9) When deformities persist in the bone of one arm
b. Disability evaluation criteria
1) In case functional disability is caused by the metal fixator installed inside the fractured
part, the disability evaluation shall be conducted after such braces are removed.
2) The resulting functional disability because the joints are not used (in case functional
disability in the joints develops after the treatment because the injured part is fixed with a
cast) and temporary disability shall not be covered by the disability benefits.
3) ¡°Arm¡± pertains to the part from the shoulder joints to the wrist joints.
4) The ¡°three major joints of the arm¡± refer to the shoulder joints, elbow joints, and wrist
joints.
5) ¡°When one arm above the wrist is severed¡± pertains to the case wherein the part from
the wrist joints to the part of the arm near the heart is amputated, including that wherein
the above part of the elbow joint is amputated.
6) The articular function disability of the arm is evaluated based on the restriction level of
the movement range of the three major arm joints, each of which shall be measured
based on the normal range and measuring method as stipulated in the ¡°Guides to the
Evaluation of Permanent Disability¡± issued by the American Medical Association (AMA).
To clarify the degree of disability, the disability angle of the affected part and the
measured value of the normal part shall be checked simultaneously to derive the
articular function disability.
a) ¡°When the function is completely lost¡± refers to the following cases:
¨ç Total ankylosis occurs, or artificial joints or artificial (femoral) heads are inserted.
¨è The electromyography result indicates total paralysis and ¡°Grade 0 (zero)¡± muscular
strength.
b) ¡°Serious disability¡± pertains to the following cases:
¨ç The total movement ranges of the relevant joints are restricted to 1/4 of the normal
movement range or less.
¨è The electromyography result indicates serious paralysis and ¡°Grade 1 (trace)¡±
muscular strength.
c) ¡°Significant disability¡± refers to the following cases:
¨ç The total movement ranges of the relevant joints are restricted to 1/2 of the normal
movement range or less.
d) ¡°Slight disability¡± pertains to the following cases:
¨ç The total movement ranges of the relevant joints are restricted to 3/4 of the normal
movement range or less.
7) ¡°When the pseudarthrosis remains and leaves significant disability¡± refers to the case
wherein the pseudarthrosis remains on the humerus or on both bones of the radius and
ulna.
8) ¡°When the pseudarthrosis remains and leaves Slight disability¡± pertains to the case
wherein the pseudarthrosis remains on either the radius or the ulna.
9) ¡°When deformities persist in the bone¡± refers to the case wherein the malformation
persists in the humerus or radius and ulna, with each malunioned malformation at 15¡Æ or
more compared to the normal level.
c. Deciding the payment rate
1) The payment rate for one upper limb (including arm and fingers) shall be totaled,
provided that it does not exceed 60%.
2) In case of functional disability involving one out of the three major joints of one arm and
on another joint, the payment rate shall apply for each affected part and summed up
accordingly
9. Disability in the legs
a. Disability classification
Disability classification
Payment Rate
100
60
30
20
10
5
20
10
5
30
15
5
1) When both legs above the ankles are severed
2) When one leg above the ankle is severed
3) When one out of the three major joints of one leg has completely
lost its function
4) When serious disability persists in one out of the three major joints
of one leg
5) When significant disability persists in one out of the three major
joints of one leg
6) When slight disability persists in one out of the three major joints of
one leg
7) When the pseudarthrosis remains on one leg and leaves major
damage
8) When the pseudarthrosis remains on one leg and leaves mild
damage
9) When deformities persist in the bone of one leg
10) When one leg is reduced by 5cm or more
11) When one leg is reduced by 3cm or more
12) When one leg is reduced by 1cm or more
b. Disability evaluation criteria
1) In case functional disability is caused by the metal fixator installed inside the fractured
part, the disability evaluation shall be conducted after such braces are removed.
2) The resulting functional disability because the joints are not used (in case functional
disability in the joints develops after the treatment because the injured part is fixed with a
cast) and temporary disability shall not be covered by the disability benefits.
3) ¡°Leg¡± pertains to the part from the hip joint to the ankle joints.
4) The ¡°three major joints of the leg¡± refer to the hip joints, knee joints, and ankle joints.
5) ¡°When one leg above the ankle is severed¡± pertains to the case wherein the part from
the ankle joints to the part of the leg near the heart is amputated, including that wherein
the above part of the ankle joint is amputated.
6) The articular function disability of the leg is evaluated based on the restriction level of the
movement range of the three major leg joints, or whether or not there is flailability. The
movement range of each joint shall be measured based on the normal range and the
measuring method stipulated in the ¡°Guides to the Evaluation of Permanent Disability¡±
issued by the American Medical Association (AMA). To clarify the degree of disability,
the disability angle of the affected part and the measured value of the normal part shall
be checked simultaneously to derive the articular function disability.
a) ¡°When the function is completely lost¡± refers to the following cases:
¨ç Total ankylosis occurs, or artificial joints or artificial (femoral) heads are inserted.
¨è The electromyography result indicates total paralysis and ¡°Grade 0 (zero)¡± muscular
strength.
b) ¡°Serious disability¡± pertains to the following cases:
¨ç The total movement ranges of the relevant joints are restricted to 1/4 of the normal
movement range or less.
¨è Objectives tests (stress X-ray) show joint instability (joints flail or move) of more than 15mm.
¨é The electromyography result indicates serious paralysis and ¡°Grade 1 (trace)¡±
muscular strength.
c) ¡°Significant disability¡± refers to the following cases:
¨ç The total movement ranges of the relevant joints are restricted to 1/2 of the normal
movement range or less.
¨è Objectives tests (stress X-ray) show joint instability (joints flail or move) of 10mm or more.
d) ¡°Slight disability¡± pertains to the following cases:
¨ç The total movement ranges of the relevant joints are restricted to 3/4 of the normal
movement range or less.
¨è Objectives tests (stress X-ray) show joint instability (joints flail or move) of 5mm or more.
7) ¡°When the pseudarthrosis remains and leaves major damage¡± refers to the case wherein
the pseudarthrosis remains on the femur or on both the tibia and fibula bones.
8) ¡°When the pseudarthrosis remains and leaves mild damage¡± pertains to the case
wherein the pseudarthrosis remains on either the tibia or fibula bone.
9) ¡°When deformities persist in the bone¡± refers to the case wherein the deformities persist
in the femur or the tibia with each malunioned malformation at 15¡Æ or more compared to
the normal level.
10) To measure the reduced length of the legs, the length from the anterior superior iliac
spine to the lower end of medial malleous of tibia shall be measured and compared
with the length of the normal legs.
In case the bony landmark used to measure the leg length is unclear, or if the
evaluation of the leg disability due to the reduced length is vague, the reduced length of
the leg shall be measured using a scanogram
c. Deciding the payment rate
1) The payment rate for one lower limb including the leg and toes shall be totaled, provided
that it does not exceed 60%.
2) In case of functional disability involving one of the three major joints of one leg and on
another joint, the payment rate shall apply for each affected part and summed up
accordingly.
10. Disability in the fingers
a. Disability classification
Disability classification
Payment Rate
55
15
10
30
10
5
1) When all five fingers of one hand are severed
2) When the first finger of one hand is severed
3) When fingers other than the first finger of one hand are severed
(for each finger)
4) When the bones of all five fingers of one hand are partially
severed, or significant disability persists in the fingers
5) When the bone of the first finger of one hand is partially severed,
or significant disability persists in the fingers
6) When the bones of the fingers other than the first finger of one
hand are partially severed, or significant disability persists in the
fingers (for each finger)
b. Disability evaluation criteria
1) The first finger has two finger joints. Starting from the joint nearest to the heart, they are
called the metacarpophalangeal joint and the interphalangeal joint.
2) The other four fingers have three finger joints each. Starting from the joint nearest to the
heart, they are called the metacarpophalangeal joint, the first phalangeal joint (proximal
interphalangeal joint) and the second phalangeal joint (distal interphalangeal joint).
3) ¡°When fingers are severed¡± pertains to the case wherein the fingers are severed from
the phalangeal joint toward the heart in the case of the first finger and from the first
phalangeal joint (proximal interphalangeal joint) toward the heart in the case of the other
four fingers.
4) ¡°When finger bones are partially severed¡± refers to the case wherein the finger bones are
severed from the phalangeal joint of the first finger away from the heart or from the first
phalangeal joint (proximal interphalangeal joint) of the other four fingers away from the
heart, or case wherein the X-ray photo clearly shows the severed bone chips.
5) ¡°When significant disability persists in the fingers¡± pertains to the case wherein the
physiological motor range of the fingers is reduced to 1/2 of the normal motor range or
less as measured based on the flexion-extension movement of the finger joints or to 1/2
of the normal motor area or less in the case of four fingers other than the first finger
when the flexion-extension movement of the first and the second phalangeal joints are
totaled.
6) In case of a disability involving two fingers, the payment rate shall apply for each
affected part and summed up accordingly.
11. Disability in the toes
a. Disability classification
Disability classification
Payment Rate
40
30
10
5
20
8
3
1) When there is loss of one foot at the Lisfranc joint or above
2) When all five toes of one foot are severed
3) When the first toe of one foot is severed
4) When toes other than the first toe of one foot are severed (for
each toe)
5) When the bones of all five toes of one foot are partially severed,
or when significant disability persists in the toes
6) When the bone of the first toe of one foot is partially severed, or
significant disability persists in the toe
7) When the bones of the toes other than the first toe of one foot are
partially severed, or significant disability persists in the toes (for
each toe)
b. Disability evaluation criteria
1) ¡°When toes are severed¡± pertains to the case wherein the first toe is severed from the
interphalangeal joint toward the heart, and the other four toes, from the first
interphalangeal joint (proximal interphalangeal joint) toward the heart.
2) ¡°When there is loss of one foot at the Lisfranc joint or above¡± refers to the case wherein
the joint between the tarsus and metatarsus, or above are amputated.
3) ¡°When the toe bones are partially severed¡± pertains to the case wherein the toe bones
are severed from the phalangeal joint of the first toe away from the heart or from the first
phalangeal joint (proximal interphalangeal joint) of the other four toes away from the
heart. Note, however, that the simple detachment of a piece of the surrounding flesh
shall not be considered ¡°severed.
4) ¡°When significant disability persists in the toe¡± refers to the case wherein the
physiological motor range of the toes is reduced to 1/2 of the normal motor range or less
as measured based on the major function of the toes, i.e., flexion-extension.
5) In case of a disability involving both toes, the payment rate shall apply for each affected
part and summed up accordingly.
12. Disability in the thoracic and abdominal organs and urinogenital organs
a. Disability classification
Disability classification
Payment Rate
75
50
20
1) When serious disability persists in the thoracicoabdominal or
urinogenital organs
2) When significant disability persists in the thoracicoabdominal or
urinogenital organs
3) When slight disability persists in the thoracicoabdominal or
urinogenital organs
b. Disability evaluation criteria
1) ¡°When serious disability persists in the thoracic and abdominal organs or urinogenital
organs¡± refers to the following cases:
¨ç Heart, lung, kidney, or liver transplant is performed.
¨è The patient requires lifetime treatment such as hemodialysis because it is impossible
for him/her to maintain life unless organ transplant is performed.
¨é The bladder has completely lost its function.
2) ¡°When significant disability persists in the thoracicoabdominal or urinogenital
organs¡° pertains to the following cases:
¨ç The entire stomach, large intestine, or pancreas have been removed.
¨è 3/4 or more of the small intestine or liver is severed.
¨é The entire testicle or ovary is removed.
3) ¡°When slight disability persists in the thoracicoabdominal or urinogenital organs¡± refers to
the following cases:
¨ç The spleen, one side of the kidney, or one side of the lung is severed.
¨è Enterostomy, urethrocele, bladder fistulae, or ureteroenterosotomy persists.
¨é Bladder capacity dropped to 50 cc or less, or urinary catheterization is needed due to
urethral stenosis.
¨ê Sex life is impossible because 1/2 or more of the penis is severed or due to the
stenosis of the vaginal orifice
¨ë An artificial anus is installed due to a functional disorder in the anal sphincter
(excluding cases wherein such the artificial anus is installed temporarily during the
process of treatment).
4) In case of restrictions to the basic activities in daily living due to a disability in the
thoracicoabdominal or urinogenital organs, the disability shall be evaluated based on the
(Table of Disabilities Restricting Activities in Daily Living (ADLs)), and a
higher payment rate shall apply.
5) Chronic diseases (including chronic liver diseases and chronic obstructive pulmonary
disease) requiring long nursing shall not be covered by the disability evaluation.
13. Nervous system and mental disorder
a. Disability classification
Disability classification
1) In case of nervous system disorders that restrict Basic
Payment Rate
10~100
100
70
40
100
80
60
40
70
40
10
Activities in Daily Living
2) If the patient requires continued observation or confinement
owing to fatal mental disorders
3) If the patient needs to be under partial observation owing to
serious mental disorders and tendency toward self-injuries or
to inflict injuries on other people persists even though
confinement is not necessary
4) If the patient is unable to go about basic social activities such
as travel via public transport or go shopping alone because of
major mental disorders
5) Fatal dementia: CDR index of 5 points
6) Serious dementia: CDR index of 4 points
7) Major dementia: CDR index of 3 points
8) Mild dementia: CDR index of 2 points
9) In case of serious fit of epilepsy
10) In case of major fit of epilepsy
11) In case of mild fit of epilepsy
b. Disability evaluation criteria
1) Nervous system
¨ç ¡°In case of nervous system disorders¡± refers to the case wherein at least one of the
five basic activities shown on the (Table of Disabilities Restricting
Activities in Daily Living (ADLs))¡± is restricted due to damaged brain, spinal cord, and
peripheral nervous system
¨è Pursuant to Item ¨ç, a disability shown on the (Table of Disabilities
Restricting Activities in Daily Living (ADLs))¡± whose payment rate is less than 10%
shall not be covered.
¨é Disabilities involving other body parts (eyes, ears, nose, arms, legs, etc.) developing
due to nervous system disorder shall be regarded as the relevant disability. In this
case, the higher payment rate shall apply.
¨ê In case of cerebral apoplexy, brain damage, and spinal cord and nervous system
disorders, the disability shall be evaluated following continuous treatment for six
months from the date of the attack or occurrence of external injuries. If the function is
deemed to improve conspicuously, or in case the patient is expected to expire
shortly even if six months have passed, disability evaluation shall be reserved for a
period of not more than six months.
¨ë The disability shall be diagnosed by rehabilitation medicine, neurosurgery, and
neurology specialists.
2) Mental disorders
¨ç For disability that does not fall under the category of the payment rate covering the
abovementioned mental disorders, the payment rate shall be calculated and paid based
on the (Table of Disabilities Restricting Activities in Daily Living (ADLs)).
¨è In principle, disability shall be evaluated 24 months after the patient is injured. If the
patient remains unconscious for 1 month or longer after sustaining such injury,
however, the disability may be evaluated 18 months after the date of occurrence of
the injury and after receiving sufficient professional treatment; otherwise, if no
sufficient treatment is received, the resulting disability or its worsening symptoms
shall not be covered.
¨é The psychological evaluation shall be carried out, and the results, reported by
licensed clinical psychological specialists.
¨ê The disability shall be diagnosed by psychiatric or neuropsychiatric specialists.
¨ë Objective basis for evaluation.
¨Í
Magnetic
resonance
imaging
(MRI),
computerized
tomography
(CT),
electroencephalogram and etc. that can prove brain function and damage are to
be performed.
¨Î Objective basis is not recognized under the following cases:
- Statement of guardians or patients
- Assumptions or recognition by appraisers
- Non-standardized, less reliable tests in Korea (e.g., brain SPECT)
- Psychological evaluation conducted by psychiatric or neuropsychiatric specialists
and corresponding report
¨ì Only organic mental disorder and post-traumatic epilepsy shall be covered.
¨í Diseases such as post-traumatic stress disorder and melancholia (reactive), various
types of neurosis such as schizophrenia, paranoia, manic depressive disorder
(affective disorder), anxiety disorders, conversion disorders, phobia, obsession
disorders, and personality disorders shall not be covered.
¨î Care for mental and/or behavioral disorders shall be recognized only when the patient is
unable to move or behave to maintain life or is in need of continued confinement. Care
shall be classified into care required to maintain life and that required to monitor behavior.
3) Dementia
¨ç ¡°Dementia¡± refers to the following:
- A disease caused by organic, post-natal sickness in the brain or damage to the
brain
- A case wherein the acquired intelligence continuously and completely deteriorates
because the brain that matured normally is destroyed by the abovementioned
organic disease.
¨è Dementia shall be evaluated by specialists based on the clinical dementia index
(Korean version: Expanded clinical dementia rating).
4) Epilepsy
¨ç ¡°Epilepsy¡± pertains to repeated seizure (including convulsion and consciousness
disorders) caused by brain disease indicating sudden electroencephalogram
abnormality.
¨è ¡°Serious epileptic seizure¡± refers to the case wherein significant seizure occurs at
least eight times a month for a period of six months or more per year, requiring
treatment and management due to the resulting respiratory disorders, aspiration
pneumonia, serious fatigue, nausea, headache, and perception disorders.
¨é ¡°Significant epileptic seizure¡± pertains to the case wherein either a significant seizure
occurs at least five times a month or a mild seizure is noted for ten times or more a
month for a period of six months or more per year.
¨ê ¡°Slight epileptic seizure ¡± refers to the case wherein either a significant seizure occurs
at least once a month or a mild seizure is recorded at least twice a month for a
period of six months or more per year.
¨ë ¡°Significant seizure¡± pertains to a seizure accompanying general convulsion,
including a seizure wherein the patient fails to maintain body balance and collapses
or that wherein unconsciousness persists for at least three minutes
¨ì ¡°Slight seizure¡± refers to the case wherein the patient can maintain body balance
independently or recover completely within three minutes even if movement
disorders occur
[Attachment] Table of Disabilities Restricting Activities in Daily
Living (ADLs)
Payment Rate Applicable Based on the Level of Restriction
- If the patient is unable to leave the room without continued help from other
persons even though he/she uses special aids (payment rate: 40%)
- If the patient cannot leave the room without the aid of a wheelchair or help from
Eating
Waste
and
Bath
Movements
Excretion
Urination
Dressing/U
ndressing
other persons (30%)
- If the patient cannot walk without using crutches or walker (20%)
- If the patient is capable of independent walking but not climbing or descending
stairways without holding on to the hand rails or continuous walking for 100m
or more on a flat ground (10%)
- If the patient cannot take food at all, receiving all or some of the required
nutrients through tube or transfusion by jugular vein intubation (20%)
- If the patient can neither use spoons and chopsticks nor take meals without
continued help from other persons (15%)
- If the patient can use spoons but not chopsticks, requiring partial help from
other persons to take in food (10%)
- If the patient is unable to use chopsticks to handle fish or cut foods even though
he/she is capable of eating independently (5%)
- If the patient continuously requires help from other persons in using the medical
systems or surgical articles installed to help facilitate waste excretion (20%)
- If the patient requires continued help from other persons in sitting on the stool
after going to the toilet (including the use of chamber pots) and in washing up
and putting on clothes following waste excretion or urination (15%)
- If the patient requires help from other persons in washing up following waste
excretion or urination even though he/she is capable of independent waste
excretion or urination (10%)
- If the patient cannot operate a vehicle, work or take lessons, etc. for more than
2 hours due to frequent and irregular excretion (5%)
- If the patient cannot dress or undress at all without continued help from other
persons (10%)
- If the patient cannot scrub his/her body although he/she can take a shower
-5%
- If the patient can scrub only certain parts of his/her body (excluding the back)
when taking a bath (3%)
- If the patient cannot dress or undress at all without continued help from other
persons (10%)
- If the patient can put on or remove either a jacket or a pair of trousers without
continued help from other persons (5%)
- If the patient can put on clothes but cannot finish dressing (e.g., buttoning and
unbuttoning, zipping up and down, tying or untying shoelaces) without the help
|