Compare keeping both, suspending personal, or suspending group Korean indemnity insurance using premiums, a confirmed refund, coverage gaps, restart timing, and expected medical costs.
Start with written confirmation from the employer and both insurers
This planner compares scenarios from the premiums, confirmed refund and effective reimbursement rates you enter. It does not approve a suspension, determine a claim, guarantee a restart product or set a legal filing deadline.
The defaults are synthetic examples, not Korean market averages. Replace them with figures from both policy schedules and written notices.
Paid while keeping both or suspending the group policy
Use only the amount confirmed as payable to the insured, not the employer cost
Use the insurer quotation when available; otherwise enter a conservative planning figure
Group suspension rider or arrangement
Enter the annual covered and non-covered medical expense you expect to bear in each coverage category.
Do not infer a rate from generation alone. Enter an effective planning rate after deductibles, exclusions and category-specific terms.
Coverage categories
Coverage categories
Overlapping benefits are not added. Within each category, the model uses no more than the larger estimated benefit of the two policies.
Lowest-cost eligible option in this input
Suspend personal
Comparable from current inputs
Household cost
₩3,010,000
Annual estimated benefit with both
₩2,070,000
Reference restart-check date
2027-09-30
Calendar date one month after the entered end date
Totals combine the entered group-coverage period and the post-group analysis period.
Available from current inputs
Annual benefit gap vs keeping both: ₩0
Directly uncovered categories: None among entered expenses
Available from current inputs
Annual benefit gap vs keeping both: ₩450,000
Annual medical-cost break-even for keeping both: ₩3,333,334
Directly uncovered categories: Disease outpatient
Available from current inputs
Annual benefit gap vs keeping both: ₩160,000
Annual medical-cost break-even for keeping both: ₩3,750,000
Directly uncovered categories: None among entered expenses
| Coverage category | Medical expense | Personal policy | Group policy | Keep both |
|---|---|---|---|---|
| Disease inpatient | ₩1,200,000 | ₩960,000 | ₩1,080,000 | ₩1,080,000 |
| Disease outpatient | ₩600,000 | ₩420,000 | ₩0 | ₩420,000 |
| Injury inpatient | ₩400,000 | ₩320,000 | ₩360,000 | ₩360,000 |
| Injury outpatient | ₩300,000 | ₩210,000 | ₩180,000 | ₩210,000 |
Official sources checked 2026-08-26
An employee who joins a Korean group indemnity medical policy may already own a personal indemnity medical policy. Keeping both contracts can preserve different coverage categories, but it does not normally double the payment for the same medical loss. Suspending one contract may reduce premiums or produce a confirmed group-policy refund, yet it can also create an outpatient gap or a difficult restart after employment ends. The practical decision therefore combines cash flow, coverage differences, eligibility, and timing rather than counting policies.
This calculator compares three scenarios on one set of assumptions: keep both policies, suspend the personal policy, or suspend the group policy. It estimates personal premiums paid, a confirmed refund to the insured, reimbursement by four coverage categories, out-of-pocket medical expense, total household cost, a reference restart-check date, and medical-cost break-even points. The result is a planning comparison, not insurance advice, a coverage determination, a claim quotation, or approval to suspend and restart a contract.
The example premiums, refund, medical expenses, effective reimbursement rates, coverage categories, and limits are not Korean market averages. They exist only to demonstrate the calculation. Replace every value with information from the personal policy schedule, the group coverage summary, the employer notice, and the insurers’ written responses. An apparently precise result is only as reliable as those inputs.
Korean indemnity medical insurance is designed to reimburse a covered loss rather than create a profit from one medical bill. Article 672 of the Commercial Act addresses multiple insurance and proportional responsibility when aggregate insured amounts exceed the insurable value. The standard business-method provisions for indemnity medical insurance also require proportional allocation when the combined contractual responsibilities exceed the eligible medical expense after the applicable deductible boundary. A policyholder should not model the two potential claim amounts as an unrestricted sum.
Different policies may still be valuable together. One group contract may omit disease outpatient care while the personal contract covers it. A group contract may have a stronger inpatient rate, while the personal contract supplies a category or a larger annual limit. The relevant question is how much incremental protection the second policy contributes after overlap, not whether both policy names appear on the employee portal.
If both policies cover disease inpatient expense, the model uses no more than the larger estimated category benefit. It does not add the two estimates.
If the group policy does not cover disease outpatient expense but the personal policy does, the personal estimate can fill that category in the keep-both scenario.
Each policy estimate is reduced to its entered annual benefit limit before the category-by-category overlap comparison is made.
This maximum-by-category method is intentionally conservative and easy to audit. It is not the insurer’s exact proportional-allocation algorithm. Actual benefits depend on covered versus non-covered services, per-visit deductions, exclusions, annual and incident limits, claim coordination, and the final review of the medical documents. Use the output to compare scenarios, then ask the insurers for the contractual treatment of a representative claim.
The current Insurance Business Supervision Work Enforcement Rules were checked on 26 August 2026. The administrative-rule serial number is 2200000108867, the administrative-rule ID is 2041116, the issue date is 13 July 2026, and the effective date is 15 July 2026. Annex 14, Article 4 contains the relevant boundaries for multiple indemnity contracts, suspension of a personal policy, operation of a group-policy suspension arrangement, withdrawal, and restart.
Under the current text, the personal contract must be valid and at least one year must have elapsed from the first coverage start for the personal-suspension arrangement. The current provision excludes senior indemnity, impaired-risk indemnity, and travel indemnity products from that personal-suspension route. The Financial Services Commission announced an expansion plan on 6 May 2026, but a policy announcement must not be treated as an effective eligibility rule before the operative rules and insurer procedures reflect it. The calculator therefore marks only a general personal indemnity policy held for at least 12 months as confirmed from the inputs.
| Decision point | Calculator treatment | Written confirmation source |
|---|---|---|
| Personal policy age | At least 12 months after the first coverage start | Personal insurer and policy record |
| Personal policy type | General indemnity is input-confirmed; excluded or unknown types require action | Policy schedule and personal insurer |
| Group suspension | Available only when the group contract operates the relevant rider or arrangement | Employer benefits team and group insurer |
| Group refund | Only the monthly amount confirmed as payable to the insured | Employer and group insurer |
| Restart timing | A calendar reference date one month after the entered end date | Personal insurer’s filing instructions |
The result adds one calendar month to the group-policy end date so that the user sees an action date. It does not decide when group coverage legally ended, whether receipt or dispatch controls the filing, how holidays are handled, or whether the insurer accepted a late filing. The current rule also allows insurer underwriting standards to apply in specified situations, including a restart request made more than one month after group coverage ends or a sufficiently long uninsured gap. Obtain the actual filing cutoff and evidence requirements from the personal insurer before the group coverage ends.
A group insurer can operate suspension through a separate rider or arrangement with the employer, and the premium attributable to suspended group coverage may be refunded to the insured under that framework. If the group policyholder rejected the rider in writing, the arrangement may not be offered. A person who receives a suspension confirmation may have a 15-day withdrawal route under the current standard method, but the starting day and filing process still require the insurer’s instructions. If the suspended personal indemnity coverage was a rider and its main policy has been terminated, restart may be unavailable.
| Input | Meaning in the model | Best evidence | Synthetic default |
|---|---|---|---|
| Current personal premium | Monthly cash outflow while the personal policy remains active | Latest premium statement | KRW 50,000 |
| Group-suspension refund | Monthly amount actually payable to the insured, not employer cost | Written employer or group-insurer notice | KRW 20,000 |
| Remaining group period | Months during which the three active-policy choices differ | Employment and group-policy dates | 24 months |
| Post-group period | Months used to expose the effect of a restarted personal premium | Personal planning horizon | 12 months |
| Restarted premium | Planning premium after a successful personal-policy restart | Personal insurer’s quotation or conservative assumption | KRW 55,000 |
| Annual medical expense | Disease and injury, each split between inpatient and outpatient | Past receipts plus planned-care scenarios | KRW 2,500,000 total |
| Effective reimbursement rate | Expected reimbursed share after deductibles and exclusions | Policy wording and a representative claim estimate | Varies by policy and setting |
| Annual benefit limit | Model cap applied to each policy’s four-category total | Coverage schedule | KRW 50m / KRW 30m |
The effective reimbursement rate is not a statutory rate and is not automatically derived from the generation of a Korean indemnity product. A generation label cannot capture benefit-category exclusions, covered and non-covered service splits, per-visit deductions, special riders, annual limits, or the employee group contract. If the exact rate is uncertain, test a lower conservative rate and separately turn an uncertain category off. That produces a more useful decision range than an optimistic single result.
For a covered category, raw estimated benefit equals annual category expense multiplied by the effective inpatient or outpatient reimbursement rate. An uncovered category has a zero benefit. If a policy’s four raw benefits exceed its entered annual limit, every category benefit is reduced proportionally so that their total equals the limit.
For each of disease inpatient, disease outpatient, injury inpatient, and injury outpatient, the keep-both benefit is the larger of the personal-policy estimate and the group-policy estimate, capped at the medical expense for that category. Adding the four selected category values produces the annual keep-both estimate.
The annual medical scenario is prorated by months. During the group period, each option uses its active benefit: both-policy benefit, group-only benefit, or personal-only benefit. During the post-group period, all three scenarios assume personal coverage is active, while the suspend-personal scenario uses the entered restarted premium.
Net premium cash flow equals personal premiums paid minus the confirmed group-suspension refund. Total household cost equals that net premium cash flow plus estimated out-of-pocket medical expense. A lower value is labelled the cost-based option only among choices marked available from the current inputs.
The calculator keeps the entered medical-expense mix constant and scales the annual total upward. Against suspending the personal policy, it searches for the first annual expense where the keep-both incremental benefit reaches the annual personal premium. Against suspending the group policy, it searches for the first annual expense where the incremental benefit reaches the annual group refund that would be forgone. Policy limits can cause the advantage to flatten or decline, so the search looks for the first reachable crossing. It reports no reachable break-even when the entered coverage mix and limits never produce enough incremental benefit.
The synthetic example assumes a KRW 50,000 current monthly personal premium, a KRW 20,000 confirmed monthly group-suspension refund, 24 months of group coverage, and a 12-month post-group period. The restarted personal premium is KRW 55,000. Annual medical expense is KRW 2,500,000: KRW 1,200,000 disease inpatient, KRW 600,000 disease outpatient, KRW 400,000 injury inpatient, and KRW 300,000 injury outpatient.
The personal example covers all four categories at effective rates of 80% inpatient and 70% outpatient, with a KRW 50,000,000 annual limit. The group example covers disease inpatient, injury inpatient, and injury outpatient, but not disease outpatient; its effective rates are 90% inpatient and 60% outpatient, with a KRW 30,000,000 annual limit. These assumptions produce annual estimated benefits of KRW 1,910,000 for personal only, KRW 1,620,000 for group only, and KRW 2,070,000 for keeping both.
| Option | Personal premiums | Group refund | Out-of-pocket | Total household cost | Important boundary |
|---|---|---|---|---|---|
| Keep both | KRW 1,800,000 | KRW 0 | KRW 1,450,000 | KRW 3,250,000 | Incremental coverage must be real after coordination |
| Suspend personal | KRW 660,000 | KRW 0 | KRW 2,350,000 | KRW 3,010,000 | Disease outpatient is directly uncovered during group coverage |
| Suspend group | KRW 1,800,000 | KRW 480,000 | KRW 1,770,000 | KRW 3,090,000 | The rider and refund must be confirmed |
Suspend personal is the lowest eligible arithmetic result in this example, but the difference from suspend group is only KRW 80,000 across three years. That narrow gap should not outweigh an unconfirmed restart, a disease-outpatient exposure, or inaccurate reimbursement rates. The correct next step is to test a high-medical-use scenario, obtain written restart and refund terms, and recalculate with those confirmed values.
The entered policies may fill meaningful gaps and the expected medical expense may be large enough that incremental reimbursement exceeds the extra premium or forgone refund. Verify that the category difference survives the actual proportional-allocation and exclusion rules.
Group coverage may be strong and the avoided personal premiums may dominate the modeled gap. Do not act unless policy type, one-year condition, suspension effectiveness, restart product, restart premium, filing cutoff, and the consequence of terminating a main policy are confirmed.
The personal policy may cover the important categories while a confirmed group refund improves cash flow. Confirm that the employer operates the arrangement, that the refund goes to the insured, and that the effective date does not create an administrative gap.
Ties are possible because the model rounds currency to Korean won. A small cost difference should be treated as a sensitivity warning, not a strong recommendation. Coverage continuity, confidence in the input evidence, ease of claims, the risk of a missed restart, and the ability to preserve an older personal contract may matter more than a narrow modeled saving.
The current standard method generally points to the suspended product, but a product-change cycle or a customer request can lead to a current or supported product under the specified framework. Requests to change coverage, a restart filed more than one month after group coverage ends, or a sufficiently long uninsured gap can trigger insurer underwriting standards. Because timing can affect both eligibility and product terms, the calendar is part of the economic decision rather than an administrative afterthought.
One medical year rarely describes the full decision. Run several scenarios and note whether the same option remains lowest and whether any direct coverage gap appears. A stable result across cautious assumptions is more informative than a single low-cost result built from optimistic rates.
| Scenario | Change to make | Decision insight |
|---|---|---|
| Ordinary year | Use a recent representative year, excluding one-time distortions | Shows recurring premium-versus-benefit economics |
| High-use year | Add a planned admission, chronic outpatient care, or injury expense | Tests whether a coverage gap becomes material |
| No confirmed refund | Set the group-suspension refund to KRW 0 | Prevents an unverified employer cost from becoming a household benefit |
| Higher restart premium | Raise the post-restart premium assumption | Shows the sensitivity of personal suspension to future product cost |
| Conservative coverage | Lower effective rates or turn uncertain categories off | Reveals reliance on unclear policy wording |
A zero category benefit in this calculator means the policy was turned off for that category or the entered rate or limit produced zero. It is a scenario flag, not a legal conclusion that the contract never covers the expense. Conversely, a positive estimate does not prove that a service is eligible. The medical records and policy wording remain controlling.
Generally no. Indemnity coverage is limited by the eligible loss, and multiple contractual responsibilities are coordinated. Two policies can still complement one another when categories, deductibles, exclusions, or limits differ.
The relevant cash flow is the amount confirmed as payable to the insured under the group-suspension arrangement. The employer premium or an industry average is not automatically the employee benefit and should not be entered as one.
The current rule checked on 26 August 2026 still excludes senior, impaired-risk, and travel indemnity from this personal-suspension route. A May 2026 expansion announcement should be separated from the operative rule and current insurer procedure.
Not in every situation. The suspended product is an important reference, but a product-change cycle, a customer request, changed coverage, delayed filing, an uninsured gap, or a terminated main policy can affect the available product or underwriting treatment.
No. It is one calendar month after the entered group end date and exists as a planning prompt. Ask the personal insurer to confirm the controlling end date, required evidence, receipt rule, holiday handling, and final filing cutoff.
Start from the actual policy schedule, then account for deductibles, covered and non-covered services, exclusions, and limits for a representative claim. If uncertain, run a conservative rate and turn an unclear category off in a separate scenario.
Its arithmetic helps explain the value of the missing arrangement or eligibility condition. The calculator excludes it from the lowest eligible cost label and displays the reason that needs confirmation.
No. It is the lowest arithmetic result under the entered assumptions, not a recommendation. Coverage continuity, restart risk, evidence quality, administrative burden, and the value of preserving a personal contract can outweigh a small modeled saving.
The policy boundary was verified on 26 August 2026 against the then-current Korean materials. The Commercial Act record used for Article 672 is law ID 001702, MST 272919, promulgated 22 July 2025 and effective 23 July 2026. The Financial Consumer Protection Act record used for the explanation-duty boundary is law ID 013704, MST 277247, promulgated 1 October 2025 and effective 2 January 2026; Article 19 covers explanations of important matters such as premiums, benefit restrictions, payment procedures, and the scope of protection.
Rules, standard policy methods, group-contract riders, and insurer procedures can change. Recheck the current administrative rule and obtain a current written answer whenever the employee’s filing date is materially later than this verification date.
Save one ordinary-year result and one high-medical-use result. Mark every category that becomes directly uncovered and every option shown as unconfirmed. Send the same question list to the employer benefits contact, the group insurer, and the personal insurer: suspension availability, insured refund, effective date, withdrawal process, group termination evidence, restart product, restart premium, filing cutoff, and final coverage start. Update the calculator with those written figures before signing or cancelling anything.