Insurance Claim Estimate Calculator

Estimate claim value after deductible, exclusions, tax or cost drag, and downside claim uncertainty.

Indemnity insurance claim estimate

Estimate the claimable payout for Korean indemnity insurance by generation, treatment type, facility, covered self-pay, uncovered cost, and annual limits.

Total claimable payout

₩250,000

Total medical cost

₩500,000

Total self-pay after claim

₩250,000

Coverage rate

50.0%

Covered payout

₩25,000

Uncovered payout

₩225,000

Uses the Korean claim-estimate engine with generation 1-5 rules, outpatient counts, annual covered and uncovered limits, and severe-case cap logic. This English finance calculator calls the same Korean pure calculation module as the Korean page. KRW and Korean statutory thresholds are preserved instead of the old generic percentage stub.

Related calculators

Indemnity insurance claim estimate guide

This English guide translates the Korean insurance claim estimate page. The calculator calls calculateClaimEstimate and preserves generation 1-5 payout rules, treatment categories, facility assumptions, annual limits, and severe-case handling.

Generation and treatment inputs

The Korean engine supports generation 1, 2, 3, 4, and 5 claim rules. Each item records treatment type, facility type, covered self-pay, and uncovered cost, then applies generation-specific deductibles and payout rates.

The default example uses outpatient care at a general hospital, but the model can also evaluate inpatient and prescription items. Covered self-pay and uncovered cost are entered separately because the payout formula and annual limits differ.

Annual limits and visit counts

Older generations can have an outpatient count rule, and the Korean page preserves the 180 outpatient visits warning. It also tracks prior paid covered amount, prior paid uncovered amount, and prior outpatient count to avoid overstating the claimable amount late in the year.

The result displays annual covered limit and annual uncovered limit effects through warnings and capped payout values. For generation 5, the severe self-pay cap can add extra protection compared with an ordinary non-severe case.

Reading the payout

The result separates covered payout, uncovered payout, deductible, total payout, total self-pay, coverage rate, and generation comparison. The highest payout generation is not always the best policy because premium and future renewal rules are outside a single claim bill.

Use this calculator to prepare a claim estimate before submitting documents, then compare it with the insurer claim statement. Contract exclusions, non-covered item classification, and policy riders can still change the final paid amount.