Meritz Fire & Marine Insurance’s medical expense insurance (often referred to as “Sibib”) continues to pay out benefits based on out-of-pocket cost criteria in 2026. Given the frequent confusion regarding musculoskeletal treatment coverage, it is essential to verify the specific conditions first. Following recent stricter regulations on manual therapy, there has been a “balloon effect” where claims to private medical expense insurance have increased. However, simply receiving treatment does not guarantee full reimbursement. If you carefully collect diagnostic certificates and receipts, you can recover the remaining hospital costs after excluding items covered by national health insurance. This article outlines the practical issues and solutions that Meritz medical expense insurance users face when filing claims, illustrated with realistic case studies.
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A Complete Guide to Meritz Medical Expense Insurance Claims and Musculoskeletal Coverage (Latest 2026 Info)
1. What are the claim pathways for medical expense insurance after manual therapy regulations?
With the recent strengthening of National Health Insurance regulations regarding manual therapy, patients are increasingly turning to private medical expense insurance. At some hospitals, items that were previously covered by insurance are now reduced or excluded, leading to a system where these costs are reimbursed through insurance companies. Data collected by Democratic Party of Korea legislator Kim Yun from five major insurance companies (Meritz, Hanwha, Samsung, Hyundai, and DB) confirms a steady increase in claims for musculoskeletal treatments. However, not all manual therapy is automatically covered; claims may be rejected during the evaluation process if there are concerns about over-diagnosis or the appropriateness of the treatment.
2. Does a history of psychiatric visits hinder insurance enrollment?
The notion that a history of psychiatric visits automatically disqualifies you from enrolling in medical expense insurance is a misconception. Although suspicions spread on social media last June, based on standards from 10 non-life insurance companies (including Meritz Fire & Marine), a history of mild depression or anxiety disorders alone is generally not sufficient grounds for rejection. However, if you have a history of severe mental illness or records of intensive treatment within the last 1-2 years, you may face rejection or partial exclusion of coverage after a risk assessment. The potential violation of the duty of disclosure prior to contracting is a major issue; therefore, you must submit your records transparently to avoid disputes when receiving insurance payouts in the future. The specific diagnostic details should be judged based on the attending medical staff’s records.
3. How are costs incurred during overseas travel handled?
You must clearly distinguish between the scope of overseas travel insurance and domestic medical expense insurance for waiting costs or medical expenses incurred abroad during business trips. As one user mentioned, many people check their overseas travel insurance separately to recover costs incurred while waiting. There are reviews praising the clean process where payment is completed on the day of application, indicating that more products with quick processing capabilities are becoming available. However, if you were diagnosed domestically and then received additional treatment abroad, this may fall under the scope of domestic medical expense insurance claims, so do not hastily claim only against overseas-specific insurance. In any case, original receipts and translations are essential, so it is correct to carefully keep supporting documents from the day of treatment.
4. What documents should be prepared to simplify the claim process?
For general outpatient claims, a medical receipt and a diagnosis certificate (or doctor’s opinion) are the basics. The fastest method is to take photos and upload them via the Meritz Fire & Marine app. Recently, simple claims through Naver Pay integration are also available, so it is best to prepare documents according to the channel you use most often. In cases where the efficacy of non-critical treatments, such as laser therapy, is difficult to verify, objective evidence like KOH test or culture test results can increase the probability of insurance payout. Instead of subjective descriptions like “I went because I was in pain,” attach objective figures or test results confirmed by medical professionals. Missing documents are the most common cause of returned claims, so it is recommended to develop the habit of checking against a checklist before submission.
5. Response strategies for claim rejection or delay
If the insurance company notifies you that “the cost is outside the coverage scope,” the staff member must specify the relevant policy clause. Rather than protesting emotionally, it is more effective to logically point out the discrepancy between the necessity of the treatment and the insurance terms. Especially in areas where legal regulations are changing, such as manual therapy, internal review criteria may be fluid, making it necessary to utilize the objection procedure. When consulting with the Meritz Fire & Marine customer service center, recording the operator’s number or the time of application serves as strong evidence in case of future disputes. If intentional non-payment is suspected, you should seriously investigate the insurance company’s internal review objection process before using the Financial Supervisory Service’s dispute consultation desk.
6. Checkpoints to verify immediately
As of today (October 1, 2026), if you have medical records within the last three years, immediately go to the “My Insurance Management” menu in the Meritz Fire & Marine app. The out-of-pocket ratio and annual limits vary depending on the version of the medical expense coverage registered (pre-2009, 2009–2017, 2017–2021, or post-2021). In particular, policies enrolled after 2021 often have a structure that includes an out-of-pocket cost of 10% per case or around 20,000 KRW, rather than 100% payment. If you file a claim without knowing this ratio, you may receive a smaller amount than expected, leading to unnecessary dissatisfaction. Also, remember to visually scan the insurance policy PDF file for any “excluded parts” or “reduced coverage parts.”
Since the out-of-pocket ratio varies by enrollment year, you must verify the out-of-pocket structure for the specific version in your insurance policy in advance.
Frequently Asked Questions
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