Health Checkup Insurance Claims: Tests and Polyp Removal ======================================================== As a rule, preventive health checkup costs are excluded from indemnity health insurance coverage. Costs for additional tests prompted by abnormal findings and polyp removal can be claimed depending on your policy terms. - Finding a disease during a health checkup does not make the entire cost of the basic checkup eligible for indemnity health insurance coverage. - Claims for additional test costs are assessed based on abnormal findings and the medical necessity of the tests. - For polyp removal, check the coverage conditions for indemnity health insurance and surgery expense riders separately. - When preparing claim documents, focus on medical expense receipts and itemized statements. - The limitation period for insurance claims is 3 years under Article 662 of the Commercial Act. Preventive health checkup costs are generally excluded from indemnity health insurance coverage. However, you may claim costs for additional tests and treatment prompted by abnormal findings. Check basic checkup costs and treatment costs separately. Coverage conditions follow your policy terms, and the claim limitation period follows the Commercial Act effective September 10, 2026. When health checkup expenses can be claimed under indemnity insurance Medical expenses incurred after a checkup are assessed based on the purpose of the tests. Medical expense insurance is an everyday term for indemnity health insurance. It reimburses the amount you actually paid for medical expenses covered by your policy. National health checkups and comprehensive company health checkups are primarily preventive. Comprehensive checkups chosen by individuals are classified using the same criteria. Additional medical expenses prompted by abnormal findings are reviewed separately. KB Kookmin Bank’s explanation also distinguishes checkup costs from additional medical expenses. Check your own policy terms for the actual payment conditions. KB Kookmin Bank guide to health checkup expense claims Tests and treatment by circumstance Even the same test may be assessed differently depending on whether it was part of a preventive checkup or additional medical care. Test or treatment received Nature of the expense What to check Basic tests in national or company health checkups Preventive Basic checkup costs are generally excluded from coverage Ultrasound or MRI added as an optional checkup item Elective screening Paying separately does not by itself make the expense covered Additional tests performed by a doctor after abnormal findings Medical care to diagnose disease Medical necessity and your policy’s coverage Removal of a polyp found during endoscopy Disease treatment Distinction between removal costs and related test costs Biopsy performed because of abnormal findings Additional diagnostic test Reason for the procedure and the actual items claimed Repeat test after a recommendation for follow-up Medical purpose needs confirmation The doctor’s decision to order the test and medical records Can sedated endoscopy costs also be claimed? Coverage for sedated endoscopy is not determined solely by whether sedation was used. Costs chosen to make a preventive checkup more comfortable are unlikely to be covered. For sedation or anesthesia costs needed for treatment, check the medical care provided and your policy terms. Even if a polyp was removed, full payment of sedation costs is not guaranteed. Check how the hospital billed the checkup items and treatment items. Whether painless endoscopy can be claimed is not determined by its name alone either. What criteria apply to ultrasound and MRI? For ultrasound and MRI, first check the purpose of the test. Additional tests to investigate abnormalities found during a checkup may be considered for coverage. The decision is not based solely on whether the test took place at a health screening center. Covered services are medical services covered by National Health Insurance. Non-covered services are those not covered by National Health Insurance. For non-covered tests, also check the coverage of your riders. The same MRI limits and deductibles cannot be applied to every policyholder. Check the MRI coverage provisions that apply to your policy. It is difficult to determine the expected payout before checking when you enrolled and which riders you have. Is a recommendation for follow-up enough to ensure coverage? The wording “follow-up” alone does not determine coverage for later test costs. You need to check why the doctor ordered another test. The assessment depends on whether testing was needed to establish a disease diagnosis during subsequent care. Comparing indemnity insurance and surgery riders for polyp removal If you had a polyp removed, check your indemnity insurance and surgery rider separately. Indemnity insurance is based on actual covered medical expenses. Fixed-benefit surgery coverage pays the agreed amount when the policy’s payment conditions are met. Category Indemnity insurance Fixed-benefit surgery rider Payment basis Actual covered medical expenses you paid A surgical procedure specified in the policy Amount calculation Accounts for out-of-pocket share and coverage limits Accounts for the insured amount, surgery classification, and other factors Documents to check Medical expense receipts, itemized statements, etc. Documents confirming the procedure name, surgery date, diagnosis, etc. Claiming both Reviewed separately from the surgery rider Reviewed separately from indemnity insurance Polyp removal must be distinguished from tissue sampling for diagnosis. Even if biopsy costs qualify for indemnity coverage, surgery benefit payment conditions are separate. LINA Life’s policy terms include a provision excluding diagnostic biopsies from the definition of surgery. LINA Life Worry-Free Health Checkup Mini Insurance policy terms EMR means endoscopic mucosal resection. ESD means endoscopic submucosal dissection. The procedure abbreviation alone cannot establish the surgery benefit amount. Compare the name of the procedure you actually received with your policy’s definition of surgery. Some policies use a surgery classification table or medical billing codes as payment criteria. You also need to check limits on the number of benefit payments separately. How do diagnosis codes and medical billing codes differ? Diagnosis codes identify diseases, while medical billing codes identify the medical procedures performed. A polyp diagnosis alone does not provide all the information about which removal procedure you received. For surgery benefit claims, check what information your policy requires. Information What it explains Documents to check Diagnosis and disease classification code The disease for which you received care Medical certificate, prescription, confirmation of medical care, etc. Procedure name and surgery date What surgery you received and when Surgery confirmation, medical certificate, etc. Medical billing code Which medical procedure was billed Itemized medical expense statement, etc. The LINA Life product mentioned above uses medical billing codes for some coverage. Hyundai Marine & Fire Insurance’s claims guide requires confirmation of details such as the procedure name and surgery date. First ask which information your own policy requires. Documents for health checkup expense claims Prepare the necessary documents, starting with medical expense receipts and itemized statements. Not every claim requires a medical certificate. Additional documents vary depending on the claim and the insurer’s requirements. Please check with the insurance company which documents to submit before filing a claim. LINA Life “Non-Participating Worry-Free Health Checkup Mini Insurance” policy terms Document What it confirms Preparation guidelines Medical bill and receipt Medical expenses actually paid Basic proof of expenses Itemized medical expense statement Costs for each test and procedure Used to distinguish checkup costs from treatment costs Prescription, confirmation of medical care, or medical certificate Diagnosis and care received Check which documents the insurer accepts Test results and medical records Abnormal findings and reasons for additional tests Submit if required Surgery confirmation and similar documents Diagnosis, procedure name, and surgery date Check when claiming surgery benefits Medication expense receipt Prescription medication costs Check when including medication costs in the claim Do not treat a card transaction slip as a substitute for a medical expense receipt. Hyundai Marine & Fire Insurance’s guide states that card transaction slips are not accepted. It also excludes medical expense payment certificates issued for income tax deductions. Hyundai Marine & Fire Insurance guide to insurance claim documents How to file a claim and check payment details Check your policy, then separate out the additional medical expenses when filing your claim. Check your insurance policy for your indemnity insurance and surgery rider coverage. Identify checkup items and additional medical care items in the itemized medical expense statement. Ask your insurer which supporting documents are needed and how to file. Submit through the channel provided, such as the insurer’s app or website. Check the payment details for excluded items and how your out-of-pocket share was applied. If the payout is lower than expected, first request the calculation details. Even covered expenses may be reduced by deductions specified in the policy. Having multiple indemnity insurance policies does not allow you to receive more than your actual loss. Samsung Fire & Marine Insurance explanation of indemnity reimbursement If payment is denied, check the applicable policy provisions and the specific reasons. If additional documents are needed, confirm what was requested and provide them. Samsung Fire & Marine Insurance’s payment procedure guide includes a process for reviewing the calculation details. Samsung Fire & Marine Insurance guide to insurance payment procedures Common mistakes in health checkup expense claims Avoid treating the total checkup cost and additional treatment costs as the same category. Do not assume that all costs, including the basic checkup fee, are covered after polyp removal. Do not judge coverage solely by the test name, such as ultrasound or MRI. Do not assume that having a biopsy also entitles you to a surgery benefit. Check which alternative documents are accepted before obtaining a medical certificate. Do not calculate your expected payout by multiplying the surgery benefit by the number of polyps. What is the deadline for filing an insurance claim? Under Article 662 of the Commercial Act, the limitation period for an insurance claim is 3 years. This is also confirmed in the Commercial Act effective September 10, 2026. If you do not exercise your right to claim, it expires when the limitation period ends. National Law Information Center: Commercial Act, Article 662 The date the limitation period starts must be checked for each individual claim. For older medical expenses, ask your insurer about the treatment date and the period in which you can file a claim. If the deadline is unclear or disputed, consider seeking legal advice. FAQ Q. Can I claim reimbursement under medical expense insurance for national health screenings or company health checkups? A. Basic preventive screening costs are generally not covered. If you received additional tests or treatment because of abnormal findings, those costs will be reviewed separately. Q. If a polyp is removed, can I be reimbursed for the full screening cost? A. The entire basic screening cost does not become eligible for coverage. Covered medical expenses, such as polyp removal, are identified and reviewed separately. Q. Can I also claim reimbursement under medical expense insurance for sedation during an endoscopy? A. Sedation chosen for a preventive screening is generally not covered. Whether the sedation or anesthesia costs were necessary for treatment must be checked against the details of the care provided and your policy terms. Q. Can I also submit claims for ultrasound and MRI scans I chose as part of a screening? A. Preventive screening items you chose yourself are generally excluded. For additional tests prompted by abnormal findings, medical necessity and the scope of coverage are checked. Q. If follow-up monitoring is recommended, will the cost of the next test also be covered? A. Coverage is not determined solely by the wording “follow-up monitoring.” The reason the doctor ordered the test during subsequent care must be checked. Q. Can I claim both medical expense insurance benefits and surgery insurance benefits for polyp removal? A. You can claim both if the conditions for each type of coverage are met. Check the details of your surgery benefit rider and whether the procedure actually performed qualifies as surgery. Q. Are surgery benefits paid even if I only have a biopsy? A. A biopsy for diagnosis must be distinguished from an excision for treatment. Surgery benefit policy terms may exclude biopsies. Q. Is it enough to submit only a card receipt? A. Do not assume that a card transaction slip can replace a medical expense receipt. Ask the hospital to issue a medical bill and receipt. Q. Is a medical certificate always required for a medical expense insurance claim? A. Not every claim requires a medical certificate. Ask your insurer whether a prescription, confirmation of medical care, or another document can be used instead. Q. If I have multiple medical expense insurance policies, will I receive benefits multiple times? A. Medical expense insurance does not reimburse more than the actual loss. If you have multiple policies, the insurers share the reimbursement amount according to the policy terms. Q. Can I also claim treatment costs incurred during a past screening? A. Under the Commercial Act, the limitation period for insurance claims is 3 years. For past medical expenses, check both the coverage in effect at the time and the limitation period for each individual claim. Sources - KB Kookmin Bank, KB's Thoughts, Can You File an Indemnity Insurance Claim for a Health Screening?, June 26, 2026: https://kbthink.com/insurance/claims/medical-checkup.html - LINA Life Non-Participating Worry-Free Health Screening Mini Insurance Policy Terms and Conditions: https://www.lina.co.kr/cms/upload/upload/docs/disclosure/B00351002_0_P.pdf - Hyundai Marine & Fire Insurance Guide to Insurance Claim Documents, Illness and Injury: https://www.hi.co.kr/FileActionServlet/preview/1/data/202409/be11216a9ad3015a1614c313610d5200.pdf/%EB%B3%B4%ED%97%98%EA%B8%88%EC%B2%AD%EA%B5%AC%EC%84%9C%28%EA%B8%B0%EB%B3%B8%29_%EC%88%98%EC%A0%95%EB%B3%B8.pdf - Samsung Fire & Marine Insurance Good Insurance Dictionary, Compensation for Actual Losses and Pro Rata Compensation Under Multiple Policies: https://product.samsungfire.com/v2/html/customer/07/F_070_010_019.html?show-element=mmList - Samsung Fire & Marine Insurance Group Accident Insurance Claim Form and Guide to the Claims Payment Process: https://m.samsungfire.com/download/claim/insurance_bill%28group2%29.pdf - Korean Law Information Center, Article 662 of the Commercial Act, effective September 10, 2026: https://www.law.go.kr/lsLinkCommonInfo.do?lsJoLnkSeq=1017094811 Images - A woman sits in a hospital bed as a doctor points to a polyp on a colon model.: https://injoys.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6NDE1OTIsInB1ciI6ImJsb2JfaWQifX0=--2b8644135f9ff6c50d25bba2876b80dc8341aa94/ai-46438eba.webp - A doctor performs an abdominal ultrasound on an older man reclining on an examination bed.: https://injoys.com/rails/active_storage/blobs/proxy/eyJfcmFpbHMiOnsiZGF0YSI6NDE1OTksInB1ciI6ImJsb2JfaWQifX0=--82d317f36f616db89c76b4472ca53b363cbf9181/ai-a06aa9b7.webp --- Category: Knowledge Base Source: https://injoys.com/en/articles/health-checkup-insurance-coverage-and-claim-documents License: cc_by Translation-Status: reviewed