Glossary of Key Terms and Concepts
Disclaimer
Preface
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

Table 1 PHI Types and Structures
Table 2 Key Features of Each PHI Generation
Table 3 Changes in Risk Rates 2018-2021
Table 4 Major PHI Companies (October 2022)
Table 5 Changes in Population with Health Insurance 2018-2022
Table 6 Changes in Age Group with NHIS Coverage 2018-2022
Table 7 Changes in Elderly Population (60+) with NHIS Coverage 2018-2022
Table 8 Amount of Reimbursement & Non-Reimbursement Care 2018-2022
Table 9 Amount of 5 Primary Reimbursement Care2022 (KRW Million)
Table 10 Number of New Contracts & Amount of Premium Revenues 2018-2022
Table 11 Changes in Profit and Loss of PHI Industry 2018-2021
Table 12 Amount of PHI Claims Approved 2021 (KRW 100 million)
Table 13 Number of New PHI Contracts
Table 14 Number of New Contracts by Age Group
Table 15 Number of New Contracts by Insurance Type
Table 16 Amount of New Contracts by Gender (in KRW)
Table 17 Amount of New Contracts by Gender and Age Group (in KRW)
Table 18 NHIS Reimbursement Expansion 2021-2022
Table 19 Comparison of Non-Reimbursements in Standard PHI Policy
Table 20 Health Insurance Coverage Rates for 4 Critical Illnesses 2021
Table 21 Benefits for Special Cases Designated as Critical Illness
Table 22 Number of Special Case Enrollees 2017-2021 (31 Dec. 2021)
Table 23 Number of Special Case Patients by Age Group 2021
Table 24 Income Group and Out-of-pocket maximums 2020-2021
Table 25 Number of Long-term Care Applications and Approvals 2017-2021
Table 26 Changes in Long-term Care Reimbursement 2017-2021
Table 27 Manual Therapy 2018-2021
Table 28 Comparison of Manual Therapy Costs (December 2022)
Table 29 Extracorporeal Shock Wave Therapy 2018-2021
Table 30 Comparison of Extracorporeal Shock Wave Therapy Costs
Table 31 Prolotherapy 2018-2021
Table 32 Comparison of Prolotherapy Costs (December 2022)
Table 33 Magnetic Resonance Imaging (MRI) 2018-2021
Table 34 Comparison of MRI Costs (December 2022)
Table 35 Cataract 2018-2021
Table 36 Comparison of Eye Test Costs (December 2022)
Table 37 Accommodative IOL Claims 2020-2022
Table 38 Comparison of Accommodative IOL Costs (December 2022)
Table 39 Uterine Myomar 2018-2021
Table 40 HIFU 2019-2021
Table 41 Comparison of HIFU costs (December 2022)
Table 42 Nasal Valve Repair 2020-2021
Table 43 Comparison of Nasal Valve Repair Costs (December 2022)
Table 44 Mastectomy 2018-2021
Table 45 Comparison of Breast Biopsy Therapeutic Materials Costs)
Table 46 Varicose Vein Surgery 2018-2021
Table 47 Thyroid Radiofrequency Ablation 2019-2021
Table 48 Comparison of TRA Costs for Benign Nodules (December 2022)
Table 49 Claims of MD Creams 2018-2022
Table 50 Likely Scenario for Strengthening Review Criteria
Table 51 Step-by-step Description of New Health Technology Assessment

Fig 1 Private Health Insurance Coverage
Fig 2 PHI Payment Method - Reimbursement Model
Fig 3 NHIS Payment Method – Third-Party Payment Model
Fig 4 Medical Bill/Receipt Sample
Fig 5 Medical Bill (Itemized Bill) Sample
Fig 6 Private Health Insurance Coverage
Fig 7 Therapeutic Materials Approval and Eligibility for PHI
Fig 8 Pharmaceuticals Approval and Eligibility for PHI