{"content_id":"bj7hstjsc2","slug":"health-screening-indemnity-insurance-claim-guide","locale":"en","schema_type":"FAQPage","category":"how_to","category_name":"How-to","title":"Can Health Checkup Costs Be Claimed Under Indemnity Medical Insurance?","summary":"As a rule, preventive health checkup costs are not covered by indemnity medical insurance, but the costs of follow-up tests or treatment prompted by abnormalities found during a checkup may be covered. Claim eligibility depends on medical records, itemized costs, enrollment date, and individual policy terms.","author":{"name":"Injoys Editorial Team","url":"https://injoys.com/ko/about"},"key_points":["Preventive checkups received while asymptomatic, such as national health screenings or comprehensive company health checkups, are generally not covered by indemnity medical insurance.","Costs for biopsies, polypectomies, and other procedures performed to diagnose or treat diseases or abnormalities found during a checkup may be covered following review.","In many cases, only additional medical expenses shown to be for treatment are covered, rather than the entire checkup cost.","Because a credit card receipt alone does not show the details of the care provided, you should prepare a medical expense receipt, itemized statement, confirmation of treatment, or procedure records.","Indemnity medical insurance benefits and fixed-benefit surgical coverage for polyp removal are reviewed under different policy terms and criteria."],"content_markdown":"Spending money on a health checkup does not mean that all of it can be reimbursed through indemnity health insurance, commonly referred to as “actual-cost insurance.” The key is whether the medical service was intended for **prevention or screening, or for the diagnosis or treatment of an already detected disease**.\n\nEven if you receive a checkup and treatment at the same medical institution on the same day, the checkup fee may be excluded, while only the costs corresponding to additional tests or procedures may be covered. The final determination is based on the terms of your policy, when you enrolled, your medical records, and the itemized medical bill.\n\n## Why Health Checkup Costs Are Generally Not Covered\n\nIndemnity health insurance covers medical expenses you actually incur due to illness or injury in accordance with the policy terms. By contrast, national health checkups, comprehensive company-sponsored checkups, and individually selected comprehensive checkups are preventive or screening tests intended to determine in advance whether an asymptomatic person has a disease.\n\nAccordingly, the following costs are generally not covered by indemnity health insurance.\n\n- Basic items included in national health checkups\n- Comprehensive checkup packages provided by a company or selected by an individual\n- Optional tests added without specific symptoms or a physician’s medical judgment\n- Costs of endoscopy, ultrasound, CT, MRI, and similar procedures performed simply to check one’s health\n- Nonmedical costs included in a checkup package, such as lodging, meals, and convenience services\n\nWhat matters is not the label “national health checkup” itself, but **the purpose of the test and the nature of the expense**. If you have symptoms and a physician orders the same test to diagnose a disease, it may be regarded as a diagnostic test rather than a health checkup.\n\n## If You Received Additional Tests or Treatment During a Checkup\n\nIf an abnormal finding is identified through a health checkup and a physician determines that diagnosis or treatment is necessary and performs an additional medical service, that portion may be covered. However, this does not mean that the entire initial checkup fee will also be covered.\n\n| Situation | General assessment | What to check |\n|---|---|---|\n| Routine upper endoscopy or colonoscopy performed without abnormal findings | Difficult to cover because it is regarded as a preventive checkup expense | Purpose of the checkup, whether it was ordered by a physician |\n| Polyp discovered and removed during a colonoscopy | The polypectomy and related medical expenses may be covered | Procedure record, diagnosis, pathology test, whether costs are separated |\n| Biopsy performed after a lesion is found during a checkup | May be covered if medical necessity is established | Test results, medical records, itemized bill |\n| Physician orders an additional test after an abnormal ultrasound finding | May be covered if intended to diagnose a disease | Connection between the abnormal finding and the additional test |\n| Expensive test added at the patient’s request without abnormal findings | Difficult to cover because it is regarded as a preventive or optional test | Whether there was a specific medical judgment by a physician |\n| Routine follow-up testing for an abnormal finding | Not automatically excluded; assessed according to medical necessity and policy terms | Existing diagnosis, follow-up test order, medical records |\n\n### When Checkup and Treatment Costs Are Paid Together\n\nA hospital may list the checkup fee and additional treatment costs on a single receipt. To distinguish covered expenses, the insurer may request an itemized medical bill, procedure confirmation, or medical records.\n\nRather than claiming the total amount of the checkup package, it is advisable to separate and submit the following items.\n\n1. Initial health checkup cost\n2. Additional consultation fees incurred after the abnormal finding was identified\n3. Biopsy and pathology test costs\n4. Treatment costs, such as polypectomy\n5. Prescription drug and medical supply costs\n\nIf the hospital cannot clearly separate the costs, the insurer may recalculate the covered amount based on the medical records and billing details.\n\n## Criteria for Assessing Endoscopy and Sedation Costs\n\nThe cost of sedated endoscopy is neither always covered nor always excluded. Sedation selected to make a basic checkup more comfortable may be regarded as an incidental checkup expense. By contrast, if it is documented as medically necessary sedation during a covered test or treatment, the outcome may differ depending on the policy terms and claims assessment.\n\nThe following factors are reviewed together when making the determination.\n\n- Whether the endoscopy itself was a health checkup or treatment for a disease\n- Whether the sedation was billed as part of the treatment process\n- The item and code under which it was listed on the itemized medical bill\n- How the applicable indemnity health insurance policy defines the expense\n\nTherefore, rather than concluding that “sedation costs can never be claimed,” it is more accurate to submit the itemized bill to the insurer for confirmation.\n\n## Check Coverage for Polyp Removal and Surgical Benefits Separately\n\nIf a gastric or colorectal polyp is removed endoscopically, you can check whether not only indemnity health insurance but also a surgical benefit rider or separate fixed-benefit surgical insurance applies.\n\nThe two types of coverage pay benefits differently.\n\n| Category | Indemnity health insurance | Fixed surgical benefit coverage |\n|---|---|---|\n| Coverage method | Reimburses eligible medical expenses actually incurred, up to the coverage limit | Pays a predetermined amount if the procedure qualifies as surgery under the policy terms |\n| Main assessment documents | Receipt, itemized bill, medical records | Surgery confirmation, diagnosis, name of surgery, policy definition of surgery |\n| Deductible | Applied according to the policy terms | Generally differs from the deductible method used for indemnity health insurance |\n| Multiple claims | Proportional reimbursement applies across multiple indemnity insurance policies | Each fixed-benefit policy is assessed according to its own terms |\n\nEven if a procedure name such as EMR or ESD is recorded, a fixed surgical benefit is not paid automatically. Nor is the decision based solely on the medical institution’s billing code. The insurer reviews the definition of surgery, surgery classification table, riders, diagnosis, and actual details of the procedure under the policy terms in effect when you enrolled.\n\n## Documents Required for an Indemnity Health Insurance Claim\n\nRequired documents may vary by insurer and claim amount, so you should first check the insurer’s official app, website, or customer service center. The following documents are generally used.\n\n### Basic Documents\n\n- Insurance claim form\n- Consent form for personal data processing and verification of medical information\n- Documents verifying the claimant’s identity\n- Bank account information for receiving the insurance payment\n- Medical bill and receipt\n- Itemized medical bill\n\n### Documents Proving Additional Tests or Procedures\n\n- Medical treatment confirmation, outpatient treatment confirmation, or medical certificate\n- Endoscopy procedure record or surgery confirmation\n- Test results and histopathology report\n- Medical records documenting the physician’s order for additional testing\n- Prescription drug receipt and prescription\n\nBecause a fee is charged for issuing a medical certificate, you do not need to obtain one in advance for every claim. It is more efficient to ask the insurer whether a medical treatment confirmation or procedure confirmation is sufficient before preparing the documents.\n\nA credit card receipt only shows that payment was made and generally does not identify the patient, treatment items, or breakdown of medical expenses. Do not submit only the card receipt; prepare the medical bill and receipt issued by the medical institution, along with the itemized bill.\n\n## Steps to Take Before Filing a Claim\n\n1. **Check your insurance coverage.** Confirm whether you have indemnity health insurance and a surgical benefit rider, as well as when you enrolled.\n2. **Separate checkup and treatment costs.** Ask the hospital’s billing office for an itemized bill showing the checkup fee, additional test fees, and procedure fees.\n3. **Obtain records showing the purpose of treatment.** Prepare documents recording the abnormal finding, physician’s judgment, diagnosis, and procedure name.\n4. **Check each insurer’s required documents.** Documentation requirements may differ for small claims and surgical benefit claims.\n5. **Claim indemnity and fixed-benefit coverage separately.** If you underwent a procedure such as polypectomy, separately check your surgical benefit rider.\n6. **Review the assessment results by item.** If only part of the claim was paid, ask which expenses were classified as checkup costs or exclusions under the policy terms.\n\n## What to Check If the Claim Is Not Paid\n\nThe fact that an insurance claim was not paid does not necessarily mean it was unfairly denied. First, ask the insurer for the reason for the denial or reduction and the applicable policy provision.\n\nReviewing the following points can help you decide whether to file an objection.\n\n- Whether the insurer separated the initial checkup fee from the additional treatment costs\n- Whether the medical records show a connection between the abnormal finding and the additional tests or treatment\n- Whether any receipts or itemized bills are missing\n- Whether the policy terms in effect when you enrolled were confused with the standards for products currently being sold\n- Whether the assessment results for indemnity health insurance and the surgical benefit rider were checked separately\n\nIf additional documentation could change the decision, you can supplement the claim with medical records or a procedure confirmation from the hospital and request reassessment. For disputes that cannot be resolved through the insurer’s explanation, you can review the Financial Supervisory Service’s financial consumer counseling and complaint procedures.\n\n## Key Takeaways\n\nThe basic cost of a health checkup is generally not covered by indemnity health insurance because it is preventive. However, if a physician performs additional testing, a biopsy, or treatment due to an abnormal finding discovered during the checkup, those medical expenses may be covered.\n\nWhat matters is not the fact that “you received a health checkup,” but **what abnormality was found, why the additional medical service was necessary, and how the costs were separated**. Because policy terms vary by insurance product and enrollment date, prepare the medical documents and then confirm the final criteria with the applicable insurer.","content_html":"\u003cp\u003eSpending money on a health checkup does not mean that all of it can be reimbursed through indemnity health insurance, commonly referred to as “actual-cost insurance.” The key is whether the medical service was intended for \u003cstrong\u003eprevention or screening, or for the diagnosis or treatment of an already detected disease\u003c/strong\u003e.\u003c/p\u003e\n\u003cp\u003eEven if you receive a checkup and treatment at the same medical institution on the same day, the checkup fee may be excluded, while only the costs corresponding to additional tests or procedures may be covered. The final determination is based on the terms of your policy, when you enrolled, your medical records, and the itemized medical bill.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#why-health-checkup-costs-are-generally-not-covered\" class=\"anchor\" id=\"why-health-checkup-costs-are-generally-not-covered\"\u003e\u003c/a\u003eWhy Health Checkup Costs Are Generally Not Covered\u003c/h2\u003e\n\u003cp\u003eIndemnity health insurance covers medical expenses you actually incur due to illness or injury in accordance with the policy terms. By contrast, national health checkups, comprehensive company-sponsored checkups, and individually selected comprehensive checkups are preventive or screening tests intended to determine in advance whether an asymptomatic person has a disease.\u003c/p\u003e\n\u003cp\u003eAccordingly, the following costs are generally not covered by indemnity health insurance.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eBasic items included in national health checkups\u003c/li\u003e\n\u003cli\u003eComprehensive checkup packages provided by a company or selected by an individual\u003c/li\u003e\n\u003cli\u003eOptional tests added without specific symptoms or a physician’s medical judgment\u003c/li\u003e\n\u003cli\u003eCosts of endoscopy, ultrasound, CT, MRI, and similar procedures performed simply to check one’s health\u003c/li\u003e\n\u003cli\u003eNonmedical costs included in a checkup package, such as lodging, meals, and convenience services\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eWhat matters is not the label “national health checkup” itself, but \u003cstrong\u003ethe purpose of the test and the nature of the expense\u003c/strong\u003e. If you have symptoms and a physician orders the same test to diagnose a disease, it may be regarded as a diagnostic test rather than a health checkup.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#if-you-received-additional-tests-or-treatment-during-a-checkup\" class=\"anchor\" id=\"if-you-received-additional-tests-or-treatment-during-a-checkup\"\u003e\u003c/a\u003eIf You Received Additional Tests or Treatment During a Checkup\u003c/h2\u003e\n\u003cp\u003eIf an abnormal finding is identified through a health checkup and a physician determines that diagnosis or treatment is necessary and performs an additional medical service, that portion may be covered. However, this does not mean that the entire initial checkup fee will also be covered.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eSituation\u003c/th\u003e\n\u003cth\u003eGeneral assessment\u003c/th\u003e\n\u003cth\u003eWhat to check\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eRoutine upper endoscopy or colonoscopy performed without abnormal findings\u003c/td\u003e\n\u003ctd data-label=\"General assessment\"\u003eDifficult to cover because it is regarded as a preventive checkup expense\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003ePurpose of the checkup, whether it was ordered by a physician\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003ePolyp discovered and removed during a colonoscopy\u003c/td\u003e\n\u003ctd data-label=\"General assessment\"\u003eThe polypectomy and related medical expenses may be covered\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eProcedure record, diagnosis, pathology test, whether costs are separated\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eBiopsy performed after a lesion is found during a checkup\u003c/td\u003e\n\u003ctd data-label=\"General assessment\"\u003eMay be covered if medical necessity is established\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eTest results, medical records, itemized bill\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003ePhysician orders an additional test after an abnormal ultrasound finding\u003c/td\u003e\n\u003ctd data-label=\"General assessment\"\u003eMay be covered if intended to diagnose a disease\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eConnection between the abnormal finding and the additional test\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eExpensive test added at the patient’s request without abnormal findings\u003c/td\u003e\n\u003ctd data-label=\"General assessment\"\u003eDifficult to cover because it is regarded as a preventive or optional test\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eWhether there was a specific medical judgment by a physician\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Situation\"\u003eRoutine follow-up testing for an abnormal finding\u003c/td\u003e\n\u003ctd data-label=\"General assessment\"\u003eNot automatically excluded; assessed according to medical necessity and policy terms\u003c/td\u003e\n\u003ctd data-label=\"What to check\"\u003eExisting diagnosis, follow-up test order, medical records\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003ch3\u003e\n\u003ca href=\"#when-checkup-and-treatment-costs-are-paid-together\" class=\"anchor\" id=\"when-checkup-and-treatment-costs-are-paid-together\"\u003e\u003c/a\u003eWhen Checkup and Treatment Costs Are Paid Together\u003c/h3\u003e\n\u003cp\u003eA hospital may list the checkup fee and additional treatment costs on a single receipt. To distinguish covered expenses, the insurer may request an itemized medical bill, procedure confirmation, or medical records.\u003c/p\u003e\n\u003cp\u003eRather than claiming the total amount of the checkup package, it is advisable to separate and submit the following items.\u003c/p\u003e\n\u003col\u003e\n\u003cli\u003eInitial health checkup cost\u003c/li\u003e\n\u003cli\u003eAdditional consultation fees incurred after the abnormal finding was identified\u003c/li\u003e\n\u003cli\u003eBiopsy and pathology test costs\u003c/li\u003e\n\u003cli\u003eTreatment costs, such as polypectomy\u003c/li\u003e\n\u003cli\u003ePrescription drug and medical supply costs\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003eIf the hospital cannot clearly separate the costs, the insurer may recalculate the covered amount based on the medical records and billing details.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#criteria-for-assessing-endoscopy-and-sedation-costs\" class=\"anchor\" id=\"criteria-for-assessing-endoscopy-and-sedation-costs\"\u003e\u003c/a\u003eCriteria for Assessing Endoscopy and Sedation Costs\u003c/h2\u003e\n\u003cp\u003eThe cost of sedated endoscopy is neither always covered nor always excluded. Sedation selected to make a basic checkup more comfortable may be regarded as an incidental checkup expense. By contrast, if it is documented as medically necessary sedation during a covered test or treatment, the outcome may differ depending on the policy terms and claims assessment.\u003c/p\u003e\n\u003cp\u003eThe following factors are reviewed together when making the determination.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eWhether the endoscopy itself was a health checkup or treatment for a disease\u003c/li\u003e\n\u003cli\u003eWhether the sedation was billed as part of the treatment process\u003c/li\u003e\n\u003cli\u003eThe item and code under which it was listed on the itemized medical bill\u003c/li\u003e\n\u003cli\u003eHow the applicable indemnity health insurance policy defines the expense\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eTherefore, rather than concluding that “sedation costs can never be claimed,” it is more accurate to submit the itemized bill to the insurer for confirmation.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#check-coverage-for-polyp-removal-and-surgical-benefits-separately\" class=\"anchor\" id=\"check-coverage-for-polyp-removal-and-surgical-benefits-separately\"\u003e\u003c/a\u003eCheck Coverage for Polyp Removal and Surgical Benefits Separately\u003c/h2\u003e\n\u003cp\u003eIf a gastric or colorectal polyp is removed endoscopically, you can check whether not only indemnity health insurance but also a surgical benefit rider or separate fixed-benefit surgical insurance applies.\u003c/p\u003e\n\u003cp\u003eThe two types of coverage pay benefits differently.\u003c/p\u003e\n\u003cdiv class=\"overflow-x-auto\"\u003e\u003ctable\u003e\n\u003cthead\u003e\n\u003ctr\u003e\n\u003cth\u003eCategory\u003c/th\u003e\n\u003cth\u003eIndemnity health insurance\u003c/th\u003e\n\u003cth\u003eFixed surgical benefit coverage\u003c/th\u003e\n\u003c/tr\u003e\n\u003c/thead\u003e\n\u003ctbody\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eCoverage method\u003c/td\u003e\n\u003ctd data-label=\"Indemnity health insurance\"\u003eReimburses eligible medical expenses actually incurred, up to the coverage limit\u003c/td\u003e\n\u003ctd data-label=\"Fixed surgical benefit coverage\"\u003ePays a predetermined amount if the procedure qualifies as surgery under the policy terms\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eMain assessment documents\u003c/td\u003e\n\u003ctd data-label=\"Indemnity health insurance\"\u003eReceipt, itemized bill, medical records\u003c/td\u003e\n\u003ctd data-label=\"Fixed surgical benefit coverage\"\u003eSurgery confirmation, diagnosis, name of surgery, policy definition of surgery\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eDeductible\u003c/td\u003e\n\u003ctd data-label=\"Indemnity health insurance\"\u003eApplied according to the policy terms\u003c/td\u003e\n\u003ctd data-label=\"Fixed surgical benefit coverage\"\u003eGenerally differs from the deductible method used for indemnity health insurance\u003c/td\u003e\n\u003c/tr\u003e\n\u003ctr\u003e\n\u003ctd data-label=\"Category\"\u003eMultiple claims\u003c/td\u003e\n\u003ctd data-label=\"Indemnity health insurance\"\u003eProportional reimbursement applies across multiple indemnity insurance policies\u003c/td\u003e\n\u003ctd data-label=\"Fixed surgical benefit coverage\"\u003eEach fixed-benefit policy is assessed according to its own terms\u003c/td\u003e\n\u003c/tr\u003e\n\u003c/tbody\u003e\n\u003c/table\u003e\u003c/div\u003e\n\u003cp\u003eEven if a procedure name such as EMR or ESD is recorded, a fixed surgical benefit is not paid automatically. Nor is the decision based solely on the medical institution’s billing code. The insurer reviews the definition of surgery, surgery classification table, riders, diagnosis, and actual details of the procedure under the policy terms in effect when you enrolled.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#documents-required-for-an-indemnity-health-insurance-claim\" class=\"anchor\" id=\"documents-required-for-an-indemnity-health-insurance-claim\"\u003e\u003c/a\u003eDocuments Required for an Indemnity Health Insurance Claim\u003c/h2\u003e\n\u003cp\u003eRequired documents may vary by insurer and claim amount, so you should first check the insurer’s official app, website, or customer service center. The following documents are generally used.\u003c/p\u003e\n\u003ch3\u003e\n\u003ca href=\"#basic-documents\" class=\"anchor\" id=\"basic-documents\"\u003e\u003c/a\u003eBasic Documents\u003c/h3\u003e\n\u003cul\u003e\n\u003cli\u003eInsurance claim form\u003c/li\u003e\n\u003cli\u003eConsent form for personal data processing and verification of medical information\u003c/li\u003e\n\u003cli\u003eDocuments verifying the claimant’s identity\u003c/li\u003e\n\u003cli\u003eBank account information for receiving the insurance payment\u003c/li\u003e\n\u003cli\u003eMedical bill and receipt\u003c/li\u003e\n\u003cli\u003eItemized medical bill\u003c/li\u003e\n\u003c/ul\u003e\n\u003ch3\u003e\n\u003ca href=\"#documents-proving-additional-tests-or-procedures\" class=\"anchor\" id=\"documents-proving-additional-tests-or-procedures\"\u003e\u003c/a\u003eDocuments Proving Additional Tests or Procedures\u003c/h3\u003e\n\u003cul\u003e\n\u003cli\u003eMedical treatment confirmation, outpatient treatment confirmation, or medical certificate\u003c/li\u003e\n\u003cli\u003eEndoscopy procedure record or surgery confirmation\u003c/li\u003e\n\u003cli\u003eTest results and histopathology report\u003c/li\u003e\n\u003cli\u003eMedical records documenting the physician’s order for additional testing\u003c/li\u003e\n\u003cli\u003ePrescription drug receipt and prescription\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eBecause a fee is charged for issuing a medical certificate, you do not need to obtain one in advance for every claim. It is more efficient to ask the insurer whether a medical treatment confirmation or procedure confirmation is sufficient before preparing the documents.\u003c/p\u003e\n\u003cp\u003eA credit card receipt only shows that payment was made and generally does not identify the patient, treatment items, or breakdown of medical expenses. Do not submit only the card receipt; prepare the medical bill and receipt issued by the medical institution, along with the itemized bill.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#steps-to-take-before-filing-a-claim\" class=\"anchor\" id=\"steps-to-take-before-filing-a-claim\"\u003e\u003c/a\u003eSteps to Take Before Filing a Claim\u003c/h2\u003e\n\u003col\u003e\n\u003cli\u003e\n\u003cstrong\u003eCheck your insurance coverage.\u003c/strong\u003e Confirm whether you have indemnity health insurance and a surgical benefit rider, as well as when you enrolled.\u003c/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eSeparate checkup and treatment costs.\u003c/strong\u003e Ask the hospital’s billing office for an itemized bill showing the checkup fee, additional test fees, and procedure fees.\u003c/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eObtain records showing the purpose of treatment.\u003c/strong\u003e Prepare documents recording the abnormal finding, physician’s judgment, diagnosis, and procedure name.\u003c/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eCheck each insurer’s required documents.\u003c/strong\u003e Documentation requirements may differ for small claims and surgical benefit claims.\u003c/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eClaim indemnity and fixed-benefit coverage separately.\u003c/strong\u003e If you underwent a procedure such as polypectomy, separately check your surgical benefit rider.\u003c/li\u003e\n\u003cli\u003e\n\u003cstrong\u003eReview the assessment results by item.\u003c/strong\u003e If only part of the claim was paid, ask which expenses were classified as checkup costs or exclusions under the policy terms.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch2\u003e\n\u003ca href=\"#what-to-check-if-the-claim-is-not-paid\" class=\"anchor\" id=\"what-to-check-if-the-claim-is-not-paid\"\u003e\u003c/a\u003eWhat to Check If the Claim Is Not Paid\u003c/h2\u003e\n\u003cp\u003eThe fact that an insurance claim was not paid does not necessarily mean it was unfairly denied. First, ask the insurer for the reason for the denial or reduction and the applicable policy provision.\u003c/p\u003e\n\u003cp\u003eReviewing the following points can help you decide whether to file an objection.\u003c/p\u003e\n\u003cul\u003e\n\u003cli\u003eWhether the insurer separated the initial checkup fee from the additional treatment costs\u003c/li\u003e\n\u003cli\u003eWhether the medical records show a connection between the abnormal finding and the additional tests or treatment\u003c/li\u003e\n\u003cli\u003eWhether any receipts or itemized bills are missing\u003c/li\u003e\n\u003cli\u003eWhether the policy terms in effect when you enrolled were confused with the standards for products currently being sold\u003c/li\u003e\n\u003cli\u003eWhether the assessment results for indemnity health insurance and the surgical benefit rider were checked separately\u003c/li\u003e\n\u003c/ul\u003e\n\u003cp\u003eIf additional documentation could change the decision, you can supplement the claim with medical records or a procedure confirmation from the hospital and request reassessment. For disputes that cannot be resolved through the insurer’s explanation, you can review the Financial Supervisory Service’s financial consumer counseling and complaint procedures.\u003c/p\u003e\n\u003ch2\u003e\n\u003ca href=\"#key-takeaways\" class=\"anchor\" id=\"key-takeaways\"\u003e\u003c/a\u003eKey Takeaways\u003c/h2\u003e\n\u003cp\u003eThe basic cost of a health checkup is generally not covered by indemnity health insurance because it is preventive. However, if a physician performs additional testing, a biopsy, or treatment due to an abnormal finding discovered during the checkup, those medical expenses may be covered.\u003c/p\u003e\n\u003cp\u003eWhat matters is not the fact that “you received a health checkup,” but \u003cstrong\u003ewhat abnormality was found, why the additional medical service was necessary, and how the costs were separated\u003c/strong\u003e. Because policy terms vary by insurance product and enrollment date, prepare the medical documents and then confirm the final criteria with the applicable insurer.\u003c/p\u003e\n","tags":["Medical indemnity insurance","Health Screening","Insurance claim","Polyp removal","Claim documents"],"faqs":[{"question":"Can the cost of a national health screening also be claimed under indemnity health insurance?","answer":"The basic tests included in a national health screening are for preventive and screening purposes, so they are generally not covered by indemnity health insurance. However, the cost of additional diagnosis or treatment performed due to abnormal findings discovered during the screening may be covered depending on the policy terms and medical records."},{"question":"Can I file an indemnity health insurance claim if a colon polyp discovered during a health screening is removed?","answer":"The examination and treatment costs related to the polypectomy may be covered. However, this does not mean that the entire cost of the initial health screening is covered, and the insurer will distinguish covered items based on documents such as the procedure record, itemized medical bill, and pathology report."},{"question":"Are biopsy costs always covered by indemnity health insurance?","answer":"They are not always covered. The medical records must document that a physician performed the biopsy because it was medically necessary to diagnose a lesion identified during the screening, and the coverage scope and deductible under your policy will also apply."},{"question":"Can the cost of sedated endoscopy also be claimed under indemnity health insurance?","answer":"The cost of sedation chosen to make a basic screening more comfortable may not be covered. However, the determination may differ if it was billed as sedation necessary for a covered diagnostic or treatment procedure, so you should review the itemized medical bill and policy terms."},{"question":"Are follow-up tests considered health screenings and therefore not covered?","answer":"They are not automatically excluded simply because they are follow-up tests. If a physician determines that a test is medically necessary to monitor an existing condition or abnormal finding, it may be recognized as a test performed for medical care, but coverage may be difficult if it is merely preventive testing."},{"question":"Is a medical certificate always required to file an indemnity health insurance claim?","answer":"A medical certificate is not required for every claim. Depending on the claim amount and the details of the medical care, a receipt, itemized bill, confirmation of medical treatment, or procedure confirmation may be sufficient, so it is advisable to check with the insurer about the required documents before paying to obtain a medical certificate."},{"question":"Can I file an insurance claim by submitting only a credit card receipt?","answer":"A credit card sales receipt alone is generally insufficient because it is difficult to verify the patient's name and details of the medical care. You need to obtain a medical expense statement and receipt, as well as an itemized medical bill, issued by the medical institution."},{"question":"Can I receive both indemnity health insurance benefits and a surgical benefit for polyp removal?","answer":"Indemnity health insurance and a fixed-benefit surgical rider provide coverage in different ways, so claims can be filed under each. However, eligibility for surgical benefits is not determined solely by the procedure name or medical billing code; it is reviewed according to the definition of surgery in the policy terms in effect at the time of enrollment and the conditions of the rider."},{"question":"What should I do if the screening and treatment costs are shown together on one receipt?","answer":"It is advisable to ask the hospital for an itemized medical bill that separately lists the screening costs, additional test costs, and procedure costs. If it is difficult to separate the costs, the insurer may review the medical records and claim details to calculate the amount eligible for coverage."}],"sources":[{"url":"https://www.fss.or.kr/fss/main/main.do","title":"Financial Supervisory Service","type":"source"},{"url":"https://fine.fss.or.kr/main/index.jsp","title":"Financial Supervisory Service Financial Consumer Information Portal FINE","type":"source"},{"url":"https://www.nhis.or.kr/nhis/index.do","title":"National Health Insurance Service","type":"source"},{"url":"https://www.hira.or.kr/main.do","title":"Health Insurance Review and Assessment Service","type":"source"}],"images":[{"id":464,"url":"https://injoys.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6NTQ5MSwicHVyIjoiYmxvYl9pZCJ9fQ==--547f86c7d39684829e75efc73e7fe320deb57b46/ai-c24fb64e.webp","is_representative":true,"generation_method":"ai_image","license":"ai_generated","mime_type":"image/webp","translations":{"ko":{"alt":"청진기, 엑스레이, 검사 샘플, 보험 방패가 표시된 건강검진 서류 일러스트","caption":"건강검진 항목과 의료비 서류, 보험 보장 여부를 상징적으로 보여준다.","description":null},"en":{"alt":"Health screening documents with a stethoscope, X-ray, test sample, and insurance shields","caption":"The illustration connects health screening records and medical bills with insurance coverage.","description":null},"ja":{"alt":"聴診器、レントゲン、検査検体、保険の盾が描かれた健康診断書類のイラスト","caption":"健康診断の項目や医療費書類と保険適用の可否を象徴的に示している。","description":null},"es":{"alt":"Documentos de chequeo médico con estetoscopio, radiografía, muestra y escudos de seguro","caption":"La ilustración relaciona el chequeo médico y sus facturas con la cobertura del seguro.","description":null},"id":{"alt":"Dokumen pemeriksaan kesehatan dengan stetoskop, rontgen, sampel tes, dan perisai asuransi","caption":"Ilustrasi ini mengaitkan pemeriksaan kesehatan dan tagihan medis dengan perlindungan asuransi.","description":null},"pt":{"alt":"Documentos de check-up com estetoscópio, raio-X, amostra de exame e escudos de seguro","caption":"A ilustração relaciona exames de saúde e despesas médicas à cobertura do seguro.","description":null},"zh-hant":{"alt":"健康檢查文件搭配聽診器、X光片、檢體與保險盾牌的插畫","caption":"插畫呈現健康檢查項目、醫療費用文件與保險理賠之間的關聯。","description":null},"de":{"alt":"Gesundheitscheck-Unterlagen mit Stethoskop, Röntgenbild, Probe und Versicherungsschilden","caption":"Die Illustration verbindet Vorsorgeuntersuchungen und Arztrechnungen mit dem Versicherungsschutz.","description":null}}},{"id":465,"url":"https://injoys.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6NTQ5NywicHVyIjoiYmxvYl9pZCJ9fQ==--e1bbb55d1a924ec684daf53522871b74fe511c5a/ai-c82f25c5.webp","is_representative":false,"generation_method":"ai_image","license":"ai_generated","mime_type":"image/webp","translations":{"ko":{"alt":"건강검진과 진료·검사 비용, 영수증, 실손보험 보장을 비교한 인포그래픽","caption":"건강검진 비용의 실손보험 청구 여부와 필요한 서류를 도식으로 보여준다.","description":null},"en":{"alt":"Infographic comparing health checkup, consultation and test costs with insurance coverage","caption":"The diagram explains insurance claims for health checkup costs and the required documents.","description":null},"ja":{"alt":"健康診断や診察・検査の費用と医療保険の補償を比較するインフォグラフィック","caption":"健康診断費用の保険請求可否と必要書類を図解している。","description":null},"es":{"alt":"Infografía sobre chequeos médicos, pruebas, costes y cobertura del seguro","caption":"El diagrama explica la cobertura de los chequeos médicos y los documentos necesarios para reclamarlos.","description":null},"id":{"alt":"Infografik pemeriksaan kesehatan, konsultasi, tes, biaya, dan perlindungan asuransi","caption":"Diagram ini menjelaskan klaim biaya pemeriksaan kesehatan dan dokumen yang diperlukan.","description":null},"pt":{"alt":"Infográfico sobre check-up médico, consultas, exames, custos e cobertura do seguro","caption":"O diagrama explica a cobertura dos custos de check-up e os documentos necessários para o reembolso.","description":null},"zh-hant":{"alt":"比較健康檢查、診療與檢查費用及實支實付保險保障的資訊圖","caption":"圖中說明健康檢查費用能否申請保險理賠及所需文件。","description":null},"de":{"alt":"Infografik zu Gesundheitscheck, Behandlung, Untersuchungskosten und Versicherungsschutz","caption":"Die Grafik erläutert die Erstattung von Gesundheitschecks und die dafür nötigen Unterlagen.","description":null}}}],"published_at":"2026-08-04T14:13:58+09:00","updated_at":"2026-08-04T14:13:58+09:00","license":"cc_by","translation_status":"reviewed","available_locales":["ko","en","ja","es"],"data_locales":["ko","en","ja","es","id","pt","zh-hant","de"],"url":"https://injoys.com/en/articles/health-screening-indemnity-insurance-claim-guide"}