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Synex Korea Healthcare Business Issue Report - Private Medical Insurance 2022

In Korea, Private Health Insurance means private insurance plans introduced to supplement the National Health Insurance Service, the nationwide public health insurance system.
When the insured with illness or injury receive medical treatments such as hospital stay, out-patient care or prescription drugs, PHI compensates the loss caused by actual medical expenses (i.e. copayment rate of NHIS reimbursement items plus 100% copayment rate of non-reimbursement items).
Currently, PHI plans are divided into four segments as follows depending on the characteristics of the insured such as age and medical history: (1) Standard plan, (2) Old-age plan, (3) Underlying-condition plan and (4) Overseas-travel plan.

As of 2022, the market size of PHI in Korea is estimated to be approximately *** million contracts in terms of cumulative number of conclusions. This estimation is based on the assumption that the average annual growth will continue to be *** % (CAGR of 2018-2021) from around *** million contracts in 2021.
This represents about *** % of the whole population (*** million persons) covered by the NHIS in Korea. In other words, *** out of *** Koreans have private indemnity health insurance plans.

Glossary of Key Terms and Concepts
Executive Summary

1 Understanding Private Indemnity Health Insurance
1.1 PHI Types
1.2 Payment Methods
1.2.1 Supporting Documents for PHI Claims
1.3 Structural Issues

2 Market Overview
2.1 NHIS Reimbursement Volume
2.1.1 NHIS Medical Expenses and Coverage Rates
2.2 Market Size of PHI
2.2.1 Number of Current PHI Contracts and Premium Revenues
2.2.2 Number of New PHI Contracts
3 Changes in PHI Coverage
3.1 Changes in NHIS Reimbursement Coverage
3.2 Changes in PHI Benefits not Covered
3.2.1 Special Cases Designated as Critical Illness
3.2.2 Out-of-Pocket Maximums
3.2.3 Long-term Care Insurance for Seniors

4 Overtreatments & Claims of Non-Reimbursement Procedures
4.1 Manual Therapy
4.2 Extracorporeal Shock Wave Therapy
4.3 Prolotherapy
4.4 Magnetic Resonance Imaging (MRI) Diagnostics
4.5 Cataract Surgery
4.6 HIFU (High Intensity Focused Ultrasound) Therapy
4.7 Nasal Valve Repair
4.8 Vacuum Assisted Breast Biopsy
4.9 Varicose Vein Surgery
4.10 Thyroid Radiofrequency Ablation
4.11 MD Creams
4.12 Likely Scenario for Strengthening Review Criteria

5 Business Strategy Suggestions for Leveraging PHI
5.1 Therapeutic Material Pricing and Eligibility for PHI
5.2 Pharmaceutical Product Pricing and Eligibility for PHI
5.3 Conclusion

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