Many consumers have given up on or postponed claiming indemnity health insurance payouts because of the hassle of having to visit the hospital again to obtain medical receipts and detailed billing statements. In particular, small-amount claims were often put off on the grounds that the effort outweighed the actual benefit. To reduce this inconvenience, the Financial Services Commission and the Korea Insurance Development Institute introduced the digitalized claims service 'Silson24.'

■ Silson24: Complete Claims Without Visiting the Hospital Desk

Silson24 is a digitalized claims service that applies to medical treatment received on or after October 25, 2024. It is structured so that treatment and prescription details are automatically transmitted to insurers through the Korea Insurance Development Institute, without the need to separately obtain documents from hospitals or pharmacies.

Users can complete the process on the Silson24 app or website in the following order: identity verification, insurance policy lookup, selection of the hospital visited along with the treatment date and details, and filling out the claim form. The biggest difference from the existing method is that the entire process, from login to claim completion, does not require a visit to the hospital desk.

However, this service can only be used at hospitals, clinics, and pharmacies linked to Silson24. Checking in advance whether an institution participates, before receiving treatment, can reduce wasted steps at the claims stage.

■ Clinic and Pharmacy Linkages Slow… Participation Encouraged Through Technical Support and Incentives

Efforts to raise the linkage rate are still ongoing. Hospital-level medical institutions and public health centers began participating relatively early, but linkages with clinics and pharmacies, which make up the majority, are growing more slowly. The main reason cited is that vendors of the electronic medical record (EMR) programs used by many clinics have been passive about linkage.

In response, the Korea Insurance Development Institute is directly providing medical institutions with technical support, such as setting up certificates and fixed IPs required for secure communication, and offering separate incentives to small institutions that do not use EMRs to encourage participation. Work to simplify the linkage procedure is also underway, and the entry burden for institutions that have delayed participation due to technical barriers is trending lower than before.

■ View Other Insurance Policies at Once… Integration with Banking and Fintech Apps Also Expanding

Improvements for consumers are also continuing. A feature has been added that allows users to look up not only indemnity health insurance payouts but also other insurance policies they hold, such as dental and illness insurance, all at once through Silson24, which is expected to help find unclaimed insurance money that policyholders forgot existed.

Integration with financial institutions is also expanding so that the digitalized claims function can be used through bank or credit card apps without installing the Silson24 app separately. In fact, KB Star Banking has incorporated Silson24-linked claims functionality into its own app, and fintech platforms such as Naver Pay, Kakao Pay, and Toss are also running medical bill claims services. While support varies by insurer, the range of options for consumers to file claims through familiar channels is widening.

In addition, personalized guidance is being pursued, such as sending notification messages when visiting a linked hospital or marking participating pharmacies and hospitals on map services. Those unfamiliar with digital devices can receive guidance on how to use the service through a dedicated call center.

■ Two Things to Check Before Using Silson24

First, check in advance whether the hospital, clinic, or pharmacy you plan to visit is linked to Silson24. At unlinked institutions, you must obtain documents directly, as in the existing method.

Second, whether the insurer you hold a policy with supports digitalized claims through other channels, such as bank or credit card apps, in addition to Silson24 varies by insurer. Checking whether the relevant function is available in the financial apps you usually use can also be a way to reduce the claims process.

[Note: Detailed implementation schedules and the scope of linked institutions may change according to follow-up announcements from the financial authorities. It is advisable to inquire with the relevant institutions in advance. AI assisted with some of this content.]