Sources#

Source ids [S#] and [R#] are carried verbatim from _research/indemnity-medical.md, the citation ground truth for this product, and are frozen — never renumber. Numbering is per product: S1 in this file is a different document from S1 in every other product’s sources.md, and the cross-product references/regulatory-and-actuarial-references.md runs its own frozen R1–R62 scheme, cited here as [REG-R#]. The two R schemes must never be read across. The sharpest instance is right here: this file’s R19 is 보험업감독규정 제7-63조 (retrieved only in a superseded vintage), while the library’s REG-R19 is 감독규정 제7-66조 이하 (해약환급금) and its REG-R17 is the 제7-63조 entry that was retrieved in full. Where the two appear together — and they do, repeatedly — that is deliberate corroboration and not redundancy. Access date for every entry: 2026-09-03.

Three tag families do three different jobs in product-spec.md, technical-notes.md and model.md:

  • [S#] — a primary product document. On this product that phrase means something it does not mean anywhere else in the repository. The benefit definition of a Korean 실손 contract is not written by a carrier: it is the 표준약관 (pyojun yakgwan, standard policy conditions) annexed to the 보험업감독업무시행세칙 at 별표 15 under 제5-13조제1항, so [S1] is published subordinate legislation and every co-payment percentage, deductible, sub-limit, count cap, renewal corridor and rating band in the specification is a clause reference rather than a market observation. The carrier documents [S3] [S4] [S5] supply what the 표준약관 does not — the 보험가입금액 menu actually sold, the 가입나이 envelope, the confirmation that there is no 해약환급금 — and the two association disclosures [S6] [S7] the price and loss-ratio outturn.

  • [R#] — a regulatory, supervisory or actuarial reference only this product needs. Twelve of the nineteen are 금융위원회 or 금융감독원 보도자료, which for 실손의료보험 are not press coverage but the operative record: the generation launches, the 할인·할증 commencement, and the annual 사업실적 that is the only published experience statement for this line.

  • [REG-R#] — the cross-product reference library, reprinted in short form at the end so that a reader of this page alone can resolve every tag on it.

Unused sources are omitted, so the [R#] scheme has one gap. R18, 금융위원회’s 「실손보험 개혁방안 주요 정책문답」 (2025-04), is retrieved in the research file but is cited by none of the three product documents: everything they take from the reform package — the 중증/비중증 boundary, the timetable, the industry profit decomposition — is carried by R4 and R5, retrieved as complete PDFs where R18 was read only as a page body. Nothing was newly retrieved at drafting and no tag was added or dropped in writing model.md.

Two retrieval facts govern how much of this product is std, and both are positive findings rather than fetch failures. 보험개발원 is the statutory 보험요율 산출기관 REG-R4 and the 장기손해보험 참조순보험요율 it publishes covers 일반상해, 교통상해, 질병 사망률, 후유장해, 입원율, 암 발생률, 비용손해, 재물손해 and 배상책임 — 실손의료보험 is not among them R20 REG-R61; and the 산출방법서 in which an insurer’s 예정위험률 and 예정사업비율 live is a 기초서류 filed under 보험업법 제5조제3호 and never published REG-R2. There is therefore no public Korean indemnity-medical morbidity or severity basis at all, and that — not an unopened document — is why every frequency, severity, persistency and expense parameter here is std.

Company and branded product names appear in this file and in _research/indemnity-medical.md and nowhere else in the library: in the three product documents a carrier is its tag alone, so a reader can always resolve who said what — here — and never has to.

Primary product sources#

Seven documents. Two are the supervisor’s own 표준약관 — the 4세대 wording this product models [S1] and the 5세대 wording that replaced it [S2] — and they are why this product’s contractual half is sourced clause by clause. Three are carrier 약관 or 상품요약서, one from each adjacent generation [S3] [S4] [S5]. Two are 손해보험협회 statutory disclosures [S6] [S7], reached through kpub.knia.or.kr REG-R62 and not the 생명보험협회 portal, because the non-life market is the larger one for 실손.

No age × sex premium scale for 4세대 or 5세대 was obtained from any source, a gap recorded at [S6], [S7] and in the provenance note. The one published premium the model calibrates on — ₩11,982 a month for a 40세 남자 — comes from a 보도자료 R1.

S1 — 보험업감독업무시행세칙 [별표 15] 표준약관 (2021.7.1. 시행), 실손의료보험 부분 (standard policy conditions)#

  • Exact titles of the two wordings used: 「기본형 실손의료보험(급여 실손의료비)」 and 「실손의료보험 특별약관(비급여 실손의료비)」

  • Publisher: 금융감독원 (Financial Supervisory Service), annexed to the 보험업감독업무시행세칙, 제5-13조제1항 관련

  • Document: [별표15]표준약관(제5-13조제1항관련)(보험업감독업무시행세칙)_.hwp, posted to the 금융감독원 「금융상품 표준약관」 board 2021-06-30, effective 2021-07-01; it carries all ten standard wordings

  • Doc type: 표준약관 — supervisor-issued standard policy conditions. A carrier’s own 실손 wording reproduces this text; there is no carrier discretion over the benefit definition, only over 보험가입금액 selection, distribution and price.

  • URL (post): https://fss.or.kr/fss/bbs/B0000115/view.do?menuNo=200504&nttId=21943

  • URL (file): https://fss.or.kr/fss/cmmn/file/fileDown.do?menuNo=200504&atchFileId=1bc99b030d0c1dd46147a7615005dcd6&fileSn=1&bbsId=

  • Accessed: 2026-09-03, Retrieved: yes (1.1 MB HWP5; the OLE compound file’s BodyText/Section0 stream was inflated and the HWPTAG_PARA_TEXT records decoded to 375,277 characters of UTF-16 text, of which the 실손의료보험 sections occupy 66,471. Tables extracted as flattened cell sequences, cell-to-column association reconstructed by eye; the inline figures and 보상기간 diagrams are drawing objects and did not extract)

  • This is the 4세대 contract itself, and the single most load-bearing document in this product — cited 152 times in product-spec.md and 82 in technical-notes.md. Everything contractual rests on it: 기본형 (급여) 보장종목 상해급여형 / 질병급여형, the 입원 80% reimbursement and the 통원 deductible max(₩10,000 clinic / ₩20,000 hospital, 20%) (제3조 <표1>); 제5조 with its ₩50,000,000 annual 보험가입금액 per 보장종목, its ₩200,000 per-visit cap and the 연간 200만원 급여 입원 자기부담 상한 (제5조제4항); the 본인부담상한제 exclusion at 제4조제3항제1호 and 제5조제3항 that truncates the 급여 claim; 제21조 보험나이; 제23조 재가입; and 제30조 the ±25% renewal corridor, whose printed illustration 14,000 → 18,200 → 23,660 → 30,758 → 39,985 → 51,980 fixes age_load = 0.04 and proves the corridor applies to the age-adjusted prior premium. On the 특별약관 side: 상해비급여형 / 질병비급여형 / 3대비급여형, the 입원 70% and the 상급병실료 50% capped at a ₩100,000 daily average, 통원 max(₩30,000, 30%) with a 100-visit cap, the three sub-limits with their counters and the 10-visit re-assessment rule, the 항암제·항생제·희귀의약품 carve-out at 제3조(3)제2항, the asymmetric act-counting rules at 제3조(3)제4항, and 제6조, the 요율 상대도 — five bands, the ₩1,000,000 surcharge floor, the 산정특례 and 장기요양 1·2등급 exemptions, and the neutrality requirement 「상대도 적용 전·후의 총 보험료 수준이 일치하도록」 from which reld_solved(y) is solved.

S2 — 보험업감독업무시행세칙 [별표 15] 표준약관 (2026.5.6. 시행), 실손의료보험 부분 (standard policy conditions, 5세대)#

  • Exact titles of the three wordings used: 「기본형 실손의료보험(급여 실손의료비)」, 「실손의료보험 특별약관1(중증 비급여 실손의료비)」 and 「실손의료보험 특별약관2(비중증 비급여 실손의료비)」

  • Publisher: 금융감독원

  • Document: [별표 15] 표준약관(제5-13조제1항관련)(보험업감독업무시행세칙).hwp, posted 2026-06-15, stated 「’26.5.6. 시행」

  • Doc type: 표준약관 — the 5세대 contract

  • URL (post): https://www.fss.or.kr/fss/bbs/B0000115/view.do?menuNo=200504&nttId=218364

  • URL (file): https://www.fss.or.kr/fss/cmmn/file/fileDown.do?menuNo=200504&atchFileId=29447dbe2fa84d85881c10281c6b9d38&fileSn=1&bbsId=

  • Accessed: 2026-09-03, Retrieved: yes (1.6 MB HWP5, same decoding route, 449,304 characters; the 실손 sections run 187,870–288,762)

  • The live market, and the direction of travel against which the modelled generation is read. It establishes the 5세대 rewrite that product-spec.md sets out in The 5세대 deltas: the 기본형 통원 deductible becoming max(₩10,000 or ₩20,000, 20%, 보장대상의료비 × 건강보험 본인부담률), with the 본인부담률 defined arithmetically inside the wording; 임신·출산 (O00–O99) and 정신발달장애 (F80–F89) brought into cover; 특별약관1 (중증 비급여) restricted to 산정특례 대상 질환 with a ₩5,000,000 annual co-payment cap on 상급종합·종합병원 inpatient treatment; and 특별약관2 (비중증 비급여) at 50% co-payment, a ₩10,000,000 annual limit, ₩200,000 per day rather than per visit for 100 days, and the outright exclusion of 근골격계 이학요법치료, 체외충격파치료 and 주사료 — the classes this model prices as claims_np_three. The 요율 상대도 table carries over unchanged into 특별약관2, which is why the experience-rating loop survives the generation change though the benefit does not.

S3 — 무배당 삼성화재 다이렉트 실손의료비보험(2605.1) 보험약관 [계약전환용] (carrier policy conditions, 5세대)#

  • Publisher: 삼성화재해상보험주식회사 (Samsung Fire & Marine Insurance)

  • Document: 보험약관, 155 pp., cover marked 2605.1 (2026-05 edition); PDF metadata created 2025-10-27, modified 2025-12-03

  • Doc type: 약관 + 약관요약서 (policy conditions with the mandatory visual summary)

  • URL: https://direct.samsungfire.com/docs/realloss.pdf

  • Accessed: 2026-09-03, Retrieved: yes (2.4 MB PDF, 157 pages of extractable text, 291,848 characters; the 요약서 infographics are images, their captions only partly extracted)

  • A carrier implementation, in the 계약전환 (conversion) form, and the source of what the 표준약관 does not say. It establishes: the menu of selectable 보험가입금액 (₩50,000,000 / ₩30,000,000 / ₩10,000,000 with the per-visit cap stepping ₩200,000 / ₩150,000 / ₩100,000), which makes model point 7’s lower rung a sourced configuration; the statement that the contract is 1년만기 순수보장성 with no 해약환급금 — the single citation behind the absence of cv_pp, claims_lapse, 보험계약대출 and 보험료 자동대출납입, and behind the 표준해약공제액 machinery of REG-R19 REG-R20 not engaging at all; the 10% 무사고 할인 and its exact scope, which is why noclaim_disc applies to the whole office premium and not only to the rider; a 5% discount for 의료급여 수급권자, excluded from the composite as [std scope]; the 재가입 rules (변경주기 최대 5년, 재가입 나이 최고 99세, cover to the 보험나이 100세 계약해당일) behind reentry_period = 5 and max_cover_age = 100; the 계약중지·재개 machinery; and the 2028-05-06 commencement of the 차등제 on 5세대 business.

S4 — 무배당 삼성화재 다이렉트 실손의료비보험(1307.1) 1종(표준형) 상품요약서 (statutory product summary, 2세대)#

  • Publisher: 삼성화재해상보험주식회사

  • Document: 상품요약서, 20 pp., 2013-07 edition

  • Doc type: 상품요약서

  • URL: https://www.anycardirect.com/docs/realloss_sum.pdf

  • Accessed: 2026-09-03, Retrieved: yes (221 KB PDF, text extracted cleanly)

  • A 2세대 (표준화실손) document, and the only retrieved source that states a 가입나이 range at all — 0–49 on this direct-channel product, the observed anchor under the composite’s std 0–65 envelope. It also sets out the pre-2017 renewal architecture — 보험기간 1년, 자동갱신 최고 14회, 보장내용 변경주기 15년, 재가입 나이 15–99, cover to the 보험나이 100세 계약해당일 — which makes the 4세대 shortening to five years legible as a supervisory decision rather than a drafting detail. It carries the 입원 80% rule and the 연간 200만원 inpatient cap in a 2세대 wording, corroborating [S1 제5조제4항], and the 하나의 상해당 최초입원일부터 365일 rule.

S5 — 무배당 프로미라이프 실손의료비보험2101 (DB손해보험) 보험약관 (carrier policy conditions, 3세대)#

  • Publisher: DB손해보험주식회사

  • Document: 보험약관, 108 pp., edition 2101 (2021-01)

  • Doc type: 약관 + 약관요약서

  • URL: https://www.idbins.com/pcweb/bizxpress/pdc/hc/__etc/실손의료비보험2101.pdf (percent-encoded form used for retrieval)

  • Accessed: 2026-09-03, Retrieved: yes (4.8 MB PDF, 154,558 characters extracted)

  • A 3세대 carrier document — the generation immediately before the model’s — whose 약관요약서 states the 3세대 deductible set verbatim: 질병통원(외래) max(병원별 공제금액 1~2만원, 20%), 질병통원(처방조제비) max(₩8,000, 20%), and the three 비급여 특약 items at max(₩20,000, 30%), the direct predecessor of the 4세대 max(₩30,000, 30%). That is what lets product-spec.md show the deductible ratcheting generation by generation rather than assert it. It also carries the 자동갱신 / 재가입 clause structure 4세대 inherits — the basis, with [S3], for the statement that the policyholder may decline a renewal and the insurer may not, which is why renewal_decline_rate is a decrement of its own.

S6 — 손해보험협회 공시실, 「실손의료보험 보험료 인상률 및 손해율 공시」 (statutory disclosure)#

  • Publisher: 손해보험협회 (General Insurance Association of Korea), 공시실

  • Doc type: 공시자료 (statutory public disclosure)

  • URL: https://kpub.knia.or.kr/productDisc/lostHealth/lostHealthIncreaseRate.do

  • Accessed: 2026-09-03, Retrieved: in part (the page structure, the insurer list, the disclosed definitions and one worked row were read; the full grid renders client-side and could not be paged through by a plain fetcher)

  • The disclosure that makes carrier-level variation measurable — 10 손해보험사 and 7 생명보험사, three years of 보험료 인상률 and three of 경과손해율, split 상해 / 질병 / 합계. Its definitions are exact and quoted in product-spec.md: 인상률 is 「직전연도말 대비 4세대 실손의료보험의 남여 각 연령별 영업보험료 인상률에 해당 성별 연령의 직전연도 보험료수익 비중을 곱하여 산정」 — a premium-weighted average over the age × sex rate scale, the disclosure’s own confirmation that such a scale exists — and 손해율 is 「발생손해액/경과보험료」. One row read in full: 메리츠화재 상해담보, 인상률 2026 21.8% and 2025 23.9%, 경과손해율 2025 117.2% and 2024 130.1%. It is also the record of a gap: the grid could not be paged, so no age × sex scale was obtained from it.

S7 — 손해보험협회 공시실 — 「실손의료보험 안내」, 「실손의료보험(5세대)」, 「보험료 비교공시」 (consumer disclosure)#

  • Publisher: 손해보험협회, 공시실

  • Doc type: 공시자료 (consumer-facing product disclosure)

  • URLs: https://kpub.knia.or.kr/pdic/mins/MinsInf.knia ; https://kpub.knia.or.kr/productDisc/lostHealth/lostHealth5thStandard.do ; https://kpub.knia.or.kr/productDisc/lostHealth/lostHealthDisclosure.do

  • Accessed: 2026-09-03, Retrieved: in part (the descriptive pages returned text; the premium comparison grid is a POST-driven form and returned 「조회된 내용이 없습니다」 to a plain fetcher)

  • The association’s own restatement of the 5세대 deductible formula — 입원 보장대상의료비 × 20%, 통원 Max[보장대상의료비 × 건강보험본인부담률, 보장대상의료비 × 20%, 1만원(병·의원) 또는 2만원(상급종합·종합병원)] — and the 5세대 annual limits, corroborating [S2] from a second publisher. Its comparison tool confirms the three marketed families (표준화 / 노후 / 유병력자) and is filtered by 성별 and 보험나이, which is the disclosure’s own confirmation that the rate scale is an age × sex table on 보험나이 — and therefore that the model’s 만나이 basis differs from the pricing basis by construction. Like [S6] it is cited as a gap: the grid returned nothing to a plain fetcher, so the nine non-anchor model points’ premiums are std rather than disclosed.

Regulatory and actuarial references#

Twenty entries in the research file; nineteen are cited here. Twelve are 금융위원회 or 금융감독원 보도자료 R1–R8 R13 R14 R16 R17, which on this product carry the operative record rather than commentary. Three describe the public layer the contract sits on top of R9 R10 R11. One is a 보험연구원 seminar deck R12, the only retrieved source for several distributional facts the model’s shape tables are calibrated on. One is the supervisory regulation itself R19, retrieved only in a superseded vintage. And one is the negative result that fixes the whole model’s basis boundary R20.

R1 — 금융위원회 외, 「7.1일부터 제4세대 실손의료보험이 출시됩니다」 (2021-06-30) (press release)#

  • Publisher: 금융위원회, joint with 금융감독원 and both trade associations

  • Document: 보도자료, 배포 2021-06-29, 보도 2021-06-30 조간, 10 pp.

  • URL (post): https://www.fsc.go.kr/no010101/76157

  • URL (file): https://www.fsc.go.kr/comm/getFile?srvcId=BBSTY1&upperNo=76157&fileTy=ATTACH&fileNo=2

  • Accessed: 2026-09-03, Retrieved: yes (438 KB PDF, 10 pp., 7,953 characters; all substantive tables extracted as machine-readable text)

  • The founding document of the modelled generation, and the source of the one number the whole model calibrates on. It recites the design intent, the 급여/비급여 split, the co-payment and deductible increases, the shortening of the 재가입주기 from 15 to 5 years, the five-band 차등제 with its thresholds and its 「5% 내외」 discount — the upper half of the range behind reld_disc_cap = 0.05 — the 10% 무사고 할인 and the launch carrier list. Its most useful item is a published 40세 남자 monthly premium comparison across all four generations at 2021-06, from which the anchor cell’s ₩11,982 comes and against which every frequency in utilisation_table.csv is solved. It also carries the tail statistic — 0.005% of insureds above ₩50,000,000 of claims in 2019 — that model.md cites for why the annual limits read slack on an expected-value grid.

R2 — 금융위원회 외, 「「4세대 실손의료보험 출시」 관련 주요 FAQ」 (2021-06) (FAQ annexed to R1)#

  • Publisher: 금융위원회 외 3

  • Document: 12 pp., 2021-06

  • URL: https://www.fsc.go.kr/comm/getFile?srvcId=BBSTY1&upperNo=76157&fileTy=ATTACH&fileNo=4

  • Accessed: 2026-09-03, Retrieved: yes (654 KB PDF, 12 pp., 6,619 characters; the two 심평원 screenshot figures did not extract)

  • The arithmetic of the 차등제 stated as a formula, and four facts the model could not be built without: that the experience record resets annually (「보험금 지급(사고) 이력이 1년마다 초기화됩니다」), which is why band_share(y, b) reads only year y − 1 and there is no bonus-malus chain; that the surcharge falls on the rider premium alone (「비급여 특약 보험료만 할증되며…」), which is why reld_avg(y) multiplies prem_np_base(y) and not prem_gross_mth(y); that the 비급여 특약 is about 60% of the total premium, which is np_share = 0.60; and the 도수치료 10-visit re-assessment rule, which physio_cont_prob = 0.60 stands in for. It also carries the worked 45-year-old-male example — the policyholder cutting his claims 93% under a surcharge — that model.md names as the behavioural response the model does not capture, and the 도수치료 price range ₩5,000–₩600,000 that justifies severity_table.csv existing.

R3 — 금융위원회, 「’24.7.1일부터 4세대 실손의료보험은 비급여 이용량에 따라 비급여 보험료가 할인 또는 할증됩니다」 (2024-06-07) (press release)#

  • Publisher: 금융위원회

  • Document: 보도자료, 2024-06-07

  • URL: https://www.fsc.go.kr/no010101/82406

  • Accessed: 2026-09-03, Retrieved: yes (HTML body read; the attached PDF was not separately opened)

  • The commencement of the 비급여 할인·할증 on 2024-07-01, three years after launch, which is reld_start_year = 4. It gives the five bands with the −5% (잠정) discount factor — the lower half of the range behind reld_disc_cap — and the +100% / +200% / +300% surcharges; the exemptions (산정특례대상질환; 장기요양 1·2등급 판정자) behind reld_exempt_share; and a band distribution at commencement, 1등급 62.1 / 2등급 36.6 / 3등급 1.3. That is not the distribution claim_shape_table.csv is calibrated to: the five-band set 72.9 / 25.3 / 0.8 / 0.7 / 0.3 is R12’s, attributed there to a 금융감독원 release of 2024-01-19, and the two published sets disagree. This entry is cited beside R12 wherever the sensitivity matters, because on this release’s own three-band mix the same neutrality identity gives r₁ = 0.9791 — a 2.1% discount against R12’s 4.25%.

R4 — 금융위원회, 「실손의료보험, 낮은 보험료로 정말 필요할 때 도움되는 보험상품으로 재탄생합니다」 (2025-04-01) (press release)#

  • Publisher: 금융위원회 (보험과)

  • Document: 보도자료, 2025-04-01 — the 실손보험 개혁방안 that became 5세대

  • URL: https://www.fsc.go.kr/no010101/84272

  • Accessed: 2026-09-03, Retrieved: yes (HTML body read; attachments not separately opened)

  • The reform’s baseline statistics, which are the market context in product-spec.md: 4천만명 insured at 2024-12-31; about 1.6천만건 of policies with no 약관변경(재가입) clause at all; national medical spend ₩133조 of which 실손 bore ₩14.1조 (10.6%) in 2023; the premium increase series 2022 14.2% → 2023 8.9% → 2024 1.5% → 2025 7.5%; and the concentration statistics — 9% of policyholders take 80% of claims, 65% take none — which are why utilisation_table.csv holds frequencies averaged over a population that mostly claims nothing, and why a single average cell cannot show what the experience rating does.

R5 — 금융위원회·금융감독원, 「5월 6일부터 … 5세대 실손의료보험이 새롭게 출시·판매됩니다」 (2026-05-06) (press release)#

  • Publisher: 금융위원회 (보험과) and 금융감독원 (보험상품분쟁2국), joint with both trade associations

  • Document: 보도자료, 배포 2026-05-04, 보도 2026-05-06 조간, 15 pp.

  • URL (post): https://www.fss.or.kr/fss/bbs/B0000188/view.do?nttId=217561&menuNo=200218

  • URL (file): https://www.fss.or.kr/fss/cmmn/file/fileDown.do?menuNo=200218&atchFileId=fa16ababffbc45d1be8ed764aa9cec3b&fileSn=2&bbsId=

  • Accessed: 2026-09-03, Retrieved: yes (655 KB PDF, 15 pp., 13,903 characters; 참고1’s 4세대-versus-5세대 comparison table extracted in full)

  • 참고1 of this release is the only retrieved document that states the complete 4세대 limit and sub-limit set in one place, which is why it is cited beside [S1] throughout the benefit provisions: it corroborates the ₩50,000,000 annual limit, the ₩200,000 per-visit cap, the ₩2,000,000 inpatient co-payment cap and all three 3대비급여 money and count caps from a second publisher. It also gives the 5세대 premium effect (−30% against 4세대) and the 계약재매입 and 선택형 할인 schemes commencing 2026-11 for the ~47.5% of in-force policies written before 2013-03 with no re-entry clause.

R6 — 금융위원회·금융감독원, 「5세대 실손보험 Q&A」 (2026-05) (annex to R5)#

  • Publisher: 금융위원회·금융감독원, 별첨1 to R5

  • URL: https://www.fss.or.kr/fss/cmmn/file/fileDown.do?menuNo=200218&atchFileId=fa16ababffbc45d1be8ed764aa9cec3b&fileSn=3&bbsId=

  • Accessed: 2026-09-03, Retrieved: yes (104 KB HWP5, decoded to 8,598 characters; the table-of-contents page numbers extracted with control-character noise, the body is clean)

  • Fifteen Q&As, four of which matter here: the four permitted 가입 유형 (주계약 alone; +특약1; +특약2; +both), the structure model points 5 and 6 exercise; a four-row table of the 국민건강보험 cost-sharing taxonomy (급여 / 선별급여 / 관리급여 / 비급여) with co-payment ranges, where the 급여/비급여 boundary is pinned; the 2025 claim mix — 비급여 근골격계 물리치료 + 주사제 27.3%, 암 관련 12.8% — which bounds the 3대비급여 share; and that the renewal increase is capped at 25% a year per risk cell, corroborating [S1 제30조].

R7 — 금융감독원, 「2025년 실손의료보험 사업실적(잠정)」 (2026-06-04) (annual experience statement)#

  • Publisher: 금융감독원 보험상품분쟁2국 보험상품제도팀

  • Document: 보도자료, 배포 2026-06-02, 보도 2026-06-04 조간, 8 pp.

  • URL (post): https://www.fss.or.kr/fss/bbs/B0000188/view.do?nttId=218168&menuNo=200218

  • URL (file): https://www.fss.or.kr/fss/cmmn/file/fileDown.do?menuNo=200218&atchFileId=cbd3c2989cfa4a71a8b2eeba98817866&fileSn=2&bbsId=

  • Accessed: 2026-09-03, Retrieved: yes (810 KB PDF, 8 pp., every numeric table extracted as machine-readable text; two bar charts are images whose axis labels did not extract)

  • The single most important experience source for this model, cited 44 times in product-spec.md. In-force counts by generation (36.22 million individual policies at 2025-12-31); premium income ₩18.0조 against ₩17.0조 of claims; claims split 급여/비급여 with the 57.1% 비급여 share; 경과손해율 overall and by generation, including 4세대 at 115.1% in 2025 against a stated break-even of 「약 85% 수준」; 손해조사비 plus 사업비 of about ₩2.9조 — 16.1% of premium, the one published expense datum, and the aggregate check_expense_split() ties the 6 / 7 / 3 split back to; claims by treatment category, including the 15.0% attributable to 암 and 뇌·심혈관질환 that anchors reld_exempt_share; the 3.3% fall in the 1–3세대 in-force block in 2025, the only 실손-specific persistency figure in existence and the anchor for both lapse_table.csv and renewal_decline_rate; and the supervisory programme for 2026 including the 4세대 재가입 conversion wave from 2026-07.

R8 — 금융감독원, 「2024년 실손의료보험 사업실적(잠정)」 (2025-05-13) (annual experience statement)#

  • Publisher: 금융감독원 보험계리상품감독국 보험상품제도팀

  • Document: 보도자료, 배포 2025-05-12, 보도 2025-05-13 조간, 7 pp.

  • URL (original post): https://www.fss.or.kr/fss/bbs/B0000188/view.do?nttId=193952&menuNo=200218

  • URL (retrieved copy): https://kiri.or.kr/PDF/weeklytrend/20250526/trend20250526_4.pdf

  • Accessed: 2026-09-03, Retrieved: yes, but through a reproduction — read from 보험연구원’s 「주간 트렌드」 republication of the 금융감독원 release (1.8 MB, 7 pp., extracted in full); the 금융감독원 posting was in the board index but its attachment was not downloaded. The reproduction is verbatim, carries the original 보도/배포 dates and 담당부서 block, and reconciles with R7’s prior-year columns, so it is treated as retrieved with the route recorded.

  • The 2024 counterpart of R7, plus two things R7 does not repeat and the model needs: the 세대별 비급여 자기부담률 and per-policy 비급여 claim table (1세대 through 4세대, inpatient and outpatient), which lets product-spec.md show the co-payment ratcheting across generations; and the 세대별 월납보험료 series 2021–2024 for a 40대 남자 at a 손해보험사, the only multi-year premium series retrieved. It is also the source of the ₩2.81조 — 18.5% of all 2024 claims — attributable to non-covered injections, which makes inject_carve_share = 0.25 a first-order calibration question rather than a detail.

R9 — 국민건강보험공단, 「2024년 건강보험 보장률 64.9%」 (2025-12-30) (official statistics)#

  • Publisher: 국민건강보험공단 비급여관리실 보장성평가센터

  • Document: 보도자료, 14 pp., reporting the 「2024년도 건강보험환자 진료비 실태조사」

  • URL (retrieved copy): https://kiri.or.kr/PDF/weeklytrend/20260105/trend20260105_1.pdf

  • Accessed: 2026-09-03, Retrieved: yes, again through the 보험연구원 「주간 트렌드」 reproduction (1.3 MB, 14 pp., 18,385 characters; all tables extracted, the two trend charts as loose number sequences). The 국민건강보험공단 original posting was not located directly.

  • The layer underneath the product. 건강보험 보장률 64.9% for 2024 with 법정 본인부담률 19.3% and 비급여 본인부담률 15.8%; national treatment cost ₩138.6조 split 보험자부담금 ₩90.0조 / 법정본인부담금 ₩26.8조 / 비급여진료비 ₩21.8조. Two of its quantities go straight into the model: the 2024 growth rates by component — scheme outlay 4.3%, statutory co-payment 1.0%, 비급여 8.1% — which are med_trend_ge and med_trend_np and therefore the whole re-rating rule; and the coverage ratios by provider type and age band, which are the std shape of the age curves in utilisation_table.csv. It also carries a 비필수항목-adjusted coverage ratio that removes 도수치료, 영양주사, 상급병실료 and 제증명수수료 — the same items the 실손 reforms target and this model sub-limits.

R10 — 국민건강보험공단, 「본인부담상한제」 (statutory scheme description)#

  • Publisher: 국민건강보험공단

  • Doc type: statutory scheme description with the year-by-year threshold table

  • URL: https://www.nhis.or.kr/nhis/minwon/wbhapa01000m01.do?mode=view&articleNo=10946900

  • Accessed: 2026-09-03, Retrieved: yes

  • The definition — 「연간 요양기관에 지출한 본인부담금이 개인별 상한액을 초과할 경우 초과액을 공단이 부담」, operated as 사전급여 and 사후환급 over the calendar year — and the income-decile threshold table for 2023–2026. This is a hard cap on the 급여 half of the 실손 claim, because [S1 제4조제3항제1호] excludes from cover any amount refundable under it, and it is the only place in the library where a public scheme reaches inside a private contract and truncates its benefit. Its 2026 scale — ₩900,000 at 1분위 to ₩8,430,000 at 10분위 — is transcribed row for row into oop_ceiling_table.csv, the only input file here that is a transcription rather than a construction, and it is what oop_trunc(y) and check_oop_ceiling() are computed against.

R11 — 건강보험심사평가원, 「외래진료시 본인부담률 및 부담액」 (statutory cost-sharing schedule)#

  • Publisher: 건강보험심사평가원 (Health Insurance Review and Assessment Service, HIRA)

  • Doc type: statutory cost-sharing schedule, stated as deriving from 국민건강보험법 시행령 별표2

  • URL: https://www.hira.or.kr/dummy.do?pgmid=HIRAA030056020110

  • Accessed: 2026-09-03, Retrieved: yes

  • The outpatient co-payment percentages by provider tier — 상급종합 / 종합병원 / 병원 / 의원, plus the pharmacy rate — that determine the 급여 본인부담금 the 실손 reimburses in every generation, and that the 5세대 wording [S2] now reads directly into its own deductible formula. Cited once, beside REG-R53.

R12 — 보험연구원 김경선, 「실손의료보험 현황 및 개선과제」 (2024-12-05) (research presentation)#

  • Seminar: KIRI 세미나 「건강보험 지속성을 위한 정책과제」

  • Publisher: 보험연구원 (Korea Insurance Research Institute), presented 2024-12-05

  • Document: seminar deck, 34 slides

  • URL: http://www.kiri.or.kr/pdf/세미나자료/smn_20241205_2.pdf (percent-encoded form used)

  • Accessed: 2026-09-03, Retrieved: yes (1.5 MB PDF, 34 pp., 12,536 characters; the charts are images whose data labels extracted but whose axes did not, so several series are quoted only where the label-to-value mapping is unambiguous from surrounding text)

  • The source of the two distributional facts the model is calibrated on, and the only retrieved document carrying either. First, the 4세대 급여-versus-비급여 loss ratio split for three half-years — 급여 97.5% and 비급여 73.0% in 2022 H1 against 154.6% and 114.2% by 2024 H1 — which is the target the utilisation level is solved to reproduce, and which establishes that the 급여 unit is the worse half, the opposite of what the 할인·할증 publicity implies. Second, the distribution of claim size by generation, which is the shape of the six 2단계 buckets in claim_shape_table.csv. It also carries the verbatim text of 보험업감독규정 제7-63조제2항제6호가목 on annual rate adequacy testing — which is why the five-year grace that left 4세대 unable to re-rate until 2025 is cited to R12 rather than to the regulation, R19 having failed to return the current article.

R13 — 금융위원회, 「’24.10.25일부터 … 실손보험 청구 전산화가 순차적으로 시행됩니다」 (2024-10-25) (press release)#

  • Publisher: 금융위원회 (보험과)

  • URL: https://www.fsc.go.kr/no010101/83255

  • Accessed: 2026-09-03, Retrieved: yes (HTML body read; the attached PDF/HWP were not separately opened)

  • The launch of 실손24, the electronic claim channel: phase 1 (병원급 with 30 or more beds, plus 보건소) from 2024-10-25, phase 2 (의원·약국) scheduled 2025-10-25, and 보험개발원 designated the statutory 전송대행기관. Cited for the friction change and explicitly recorded as not modelled: lower claim friction is a plausible driver of future frequency, no published elasticity exists, and nothing in the basis is adjusted for it.

R14 — 금융위원회, 「실손보험 청구 전산화가 의원·약국을 포함하여 확대 시행됩니다」 (2025-10-23) (press release)#

  • Publisher: 금융위원회

  • URL: https://fsc.go.kr/no010101/85456

  • Accessed: 2026-09-03, Retrieved: yes (HTML body read)

  • Phase 2 of 실손24 from 2025-10-25: the provider counts (104,541 in scope, 10,920 — 10.4% — connected at launch), the documents transmitted (계산서·영수증, 진료비 세부산정내역서, 처방전) and the confidentiality constraint on the 전송대행기관. Cited with R13 and, like it, recorded as a driver the model does not assume.

R15 — 금융위원회, 「보험업법 시행령·감독규정 입법예고」 (2026-01-15) (legislative pre-announcement)#

  • Publisher: 금융위원회

  • Document: 보도자료, 2026-01-15; 예고기간 2026-01-15 ~ 2026-02-25

  • URL: https://www.fsc.go.kr/no010101/86059

  • Accessed: 2026-09-03, Retrieved: yes (HTML body read; the draft 개정안 attachments were not opened)

  • Confirms the instrument chain this product’s benefit definition hangs on: the 5세대 상품설계기준 sits in the 보험업법 시행령 and the 보험업감독규정, with the detail delegated to the 시행세칙 — i.e. [S2] is the operative text and the 감독규정 REG-R17 its enabling instrument. It also states the 5세대 design constraints: 급여 통원 co-payment linked to the 건강보험 본인부담률 with a 20% floor; 중증 비급여 30% with a ₩30,000 minimum; 비중증 비급여 50% with a ₩50,000 minimum.

R16 — 금융감독원, 「최근 민원사례로 알아보는 실손의료보험 관련 소비자 유의사항」 (2026-05-19) (press release)#

  • Publisher: 금융감독원 소비자소통국 손해보험민원팀

  • URL: https://www.fss.or.kr/fss/bbs/B0000188/view.do?nttId=217901&menuNo=200218

  • Accessed: 2026-09-03, Retrieved: in part (the page body and the attachment list were read; the attachments were not opened)

  • Four complaint patterns, two of which bear on the model: the 개인실손 중지제도 — suspension while a group 실손 is in force, with resumption within one month of the group cover ending — which is suspend_rate, the fourth decrement, live on model point 9 and mandatory as a facility under 감독규정 제7-63조제2항제7호 REG-R17; and the 6-month conversion withdrawal right. The resumption half is named in model.md as not modelled: the contract that resumes is a different projection.

R17 — 금융위원회, 「(노후·유병력자) 실손보험의 가입연령과 보장연령을 확대하여 …」 (2025-02-11) (press release)#

  • Publisher: 금융위원회

  • URL: https://www.fsc.go.kr/no010101/83985

  • Accessed: 2026-09-03, Retrieved: yes (HTML body read)

  • The two adjacent families — 노후실손 and 유병력자실손 — and the 2025-04-01 widening of their issue and cover ages to 90. Relevant twice: R7 reports them as a separate 2.4% block outside the five generations, and they carry their own co-payments, issue ages and three-year change cycles, so product-spec.md scopes them out explicitly. The 90-year issue age is the observed upper bound against which the std 0–65 envelope is set.

R19 — 보험업감독규정 (금융위원회고시) 제7-63조 (제3보험의 보험상품설계 등) (financial-regulatory notification)#

  • Publisher: 금융위원회

  • Doc type: 행정규칙 (고시)

  • URLs tried: https://www.law.go.kr/admRulLsInfoP.do?admRulSeq=2100000220196 ; https://law.go.kr/LSW/admRulLsInfoP.do?admRulSeq=2100000235980 ; https://www.fsc.go.kr/comm/getFile?srvcId=BBSTY1&upperNo=24827&fileTy=ATTACH&fileNo=10 ; https://www.easylaw.go.kr/CSP/FlDownload.laf?flSeq=317766

  • Accessed: 2026-09-03, Retrieved: in part, and the part that matters was not retrieved. The 국가법령정보센터 pages return only the masthead and amendment metadata to a plain fetcher (시행 2023-03-02, 고시 제2023-10호 on one; 시행 2024-01-31, 제2024-9호 on another) — the article text is JavaScript-rendered. Two HWP copies were downloaded and decoded, but both are a pre-2013 vintage whose 제7-63조 has only three 호 and no 제2항 at all, so the current 제7-63조제2항, where the 실손 design rules live, was not retrieved from this route.

  • What was read is 제7-63조 as it stood after the 2011-03-22 전문개정, including 제1항제2호: 「약관상 보장하는 금액은 정액 또는 실제 발생하는 손해(이하 “실손해”라 한다)를 기준으로 설계할 것」. That single clause is the structural fact the whole product rests on — the branch of 제3보험 design that makes an indemnity benefit lawful, and the reason Medical_KR_S stands alone in krlib. Everything about the current 제2항 — the 5년 재가입주기, the ±25% corridor, the 중지·재개 facility, the annual rate adequacy test — is cited to REG-R17, which retrieved the article in full, and 제2항제6호가목 specifically to R12, which quotes it verbatim.

R20 — 보험개발원, 「장기손해보험 참조순보험요율 예시」 (reference net premium rate disclosure)#

  • Publisher: 보험개발원 (Korea Insurance Development Institute, KIDI)

  • Doc type: 참조순보험요율 disclosure

  • URL: https://www.kidi.or.kr/user/nd13261.do

  • Accessed: 2026-09-03, Retrieved: yes

  • The negative result that fixes this model’s basis boundary, and it is cited as such. The published reference-rate categories for 장기손해보험 as applied from 2024-04-01 are 일반상해 and 교통상해 (사망/후유장해/입원), 질병 사망률, 후유장해, 입원율, 암 발생률, 비용손해, 재물손해 and 배상책임 — 실손의료보험 위험률 is not among them. With the unpublished 산출방법서 REG-R2 that is what makes every claim frequency, severity, persistency and expense parameter here std and constructed from the aggregate experience of R7 R8 R12. The same display carries a 질병입원율 grid usable as an external anchor for the age slope of adm_rate REG-R61; both technical-notes.md and model.md record that it is deliberately not used for the level, and why.

Cross-product references ([REG-R#])#

[REG-R#] tags resolve against references/regulatory-and-actuarial-references.md, whose own R1–R62 numbering is distinct from this file’s and is likewise frozen. Within that page a plain [R#] refers to its own entries, so the two schemes must never be read across. The thirty-four entries the indemnity medical documents cite, all accessed 2026-09-03:

  • REG-R1 — 보험업법 제2조·제4조: 제2조제1호나목 carves 질병·상해·간병 out of 손해보험 and 제4조제1항제3호 makes them a category of their own, which places this contract in 제3보험 — 상해보험 and 질병보험 at once, the 표준약관 writing 상해 and 질병 as separate 보장종목 with separate limits. Retrieved: yes (full Act, 127,346 characters).

  • REG-R2 — 보험업법 제5조·제127조 등 (기초서류): the 산출방법서 is a 기초서류 filed with the FSC and never published, which is why every pricing-basis parameter here is std and why the 가입나이 envelope is a 사업방법서 matter. Retrieved: yes.

  • REG-R3 — 보험업법 제120조: the statutory duty to accumulate 책임준비금 and 비상위험준비금, carrying no method and no rate itself. Cited only to place the reserve outside this projection. Retrieved: yes.

  • REG-R4 — 보험업법 제176조 (보험요율 산출기관): the statutory footing of 보험개발원 and of the 참조순보험요율 regime — the instrument that makes R20’s omission of 실손의료보험 a legally meaningful fact rather than an editorial choice. Retrieved: yes.

  • REG-R5 — 보험업법 제181조·제184조: the 선임계리사 and the 제184조제7항 bar on holding the product-development, CEO or CFO role. Retrieved: yes.

  • REG-R6 — 보험업법 제108조 (특별계정): cited once, to record that a 특별계정 does not arise on this contract. Retrieved: yes.

  • REG-R7 — 보험업법 시행령 제1조의2 (보험상품): the Decree-level product taxonomy that puts 실손 in 질병보험 and 상해보험 simultaneously. Retrieved: yes (153,076 characters).

  • REG-R8 — 보험업법 시행령 제63조·제65조·제71조: the reserve taxonomy under 제120조. Cited as a layer this model does not compute. Retrieved: yes.

  • REG-R9 — 보험업감독규정 (고시 제2026-16호), 본문: among much else the 기준연령 요건 of 제1-2조제2호 making male 40 the prescribed disclosure cell, which is why the anchor model point is a 40세 남자 and why R1’s premium for that life is the calibration target. Retrieved: yes (226,083 characters, the whole 고시).

  • REG-R11 — 감독규정 제6-11조의6 (해약환급금준비금): the appropriation with no counterpart anywhere else in this repository, cited for the reason it is inert here — a contract with no surrender value gives it nothing to bite on. Retrieved: yes.

  • REG-R12 — 감독규정 제6-11조의7·제6-13조 (계약자배당): cited once, to record that this 순수보장성 contract distributes nothing. Retrieved: yes.

  • REG-R13 — 감독규정 제7-1조 등 (K-ICS 지급여력): the solvency layer, and the 해지위험 and 대량해지 shocks in particular — a one-year renewable indemnity contract is the archetype of a product whose contract boundary decides its capital charge. Retrieved: yes (article text; 별표 22 was not retrieved).

  • REG-R15 — 감독규정 제5-6조·제5-7조·제6-26조 (특별계정): cited with REG-R6, to record that it does not arise. Retrieved: yes.

  • REG-R17 — 감독규정 제7-63조 (제3보험의 보험상품설계), retrieved in full, and therefore the entry carrying every current-vintage clause R19 could not return. Cited 31 times in product-spec.md and 20 in technical-notes.md: 제1항제1호 (nothing but the 책임준비금 on death from a non-covered cause, hence no claims_death), 제1항제2호 (the 실손해 design branch), 제2항제2호 (the ₩2,000,000 inpatient cap), 제2항제3호·제3의2호 (the ±25% corridor per 위험구분단위), 제2항제5호 (the 노후·유병력자 families), 제2항제6호가목 (the rate-adequacy test and its five-year grace), 제2항제6호나목 (the 5년 재가입주기) and 제2항제7호 (the mandatory 중지·재개 facility). Retrieved: yes.

  • REG-R19 — 감독규정 제7-66조 등 (해약환급금): cited once and only to record that the standard surrender-value machinery does not engage, there being no surrender value. Retrieved: yes (operative words in full; the formula display did not extract). Not this file’s R19.

  • REG-R20 — 감독규정 [별표 14] 표준해약공제액: likewise cited to record that the surrender charge cap has nothing to bite on. Retrieved: yes (1-page PDF, full text).

  • REG-R22 — 감독규정 제4-32조·제7-45조·제7-51조: 제4-32조제5항 caps first-year commission on a 보장성보험 at one year’s premium and is nowhere near binding at comm_rate = 0.06; and 제7-45조제7항 requires the 보험가격지수 to be explained at every renewal of a 실손 contract, not only at sale — an obligation that exists because the price moves annually. Retrieved: yes.

  • REG-R23 — 보험업감독업무시행세칙 (금융감독원세칙): the instrument whose 제5-13조제1항 makes 별표 15 the 표준약관, and therefore the reason [S1] is subordinate legislation rather than a carrier document. Retrieved: yes (114,610 characters).

  • REG-R25 — 시행세칙 [별표 15] 표준약관: the same annex as [S1], retrieved independently as a 492-page PDF in the cross-product pass and cited 33 times where the load-bearing statement is the general one — 제21조 보험나이, 제22조 (death from a non-covered cause), 제17조 청약철회, and the general provisions the 실손 wordings inherit. Where the statement is specific to the 실손 text the documents cite [S1]. Retrieved: yes.

  • REG-R33 — 보험개발원 제10회 경험생명표, as reported by 보험매일: the industry table is released as summary statistics only, the first of the two reasons mort_table.csv is a construction. Retrieved: yes — but it is a news article, the KIDI announcement itself not being retrievable.

  • REG-R38 — 국가데이터처 「2024년 생명표 작성 결과」 and 통계청 「2023년 생명표」: the public national table, whose 기대수명, 기대여명 at 40 and 65 and survival to 80 are the four statistics the shipped Makeham fit reproduces. Retrieved: yes.

  • REG-R39 — KOSIS 완전생명표 (single-year qx): Retrieved: no — distributed through the KOSIS interface rather than as a fetchable file, which is the second reason mort_table.csv is a fit to summary statistics rather than a graduation of rates.

  • REG-R41 — 국민건강보험공단 「2024년도 건강보험환자 진료비 실태조사」: the survey behind R9, cited beside it for the coverage ratios by provider class and age band that shape utilisation_table.csv and the component growth rates that are med_trend_ge and med_trend_np. Retrieved: yes (PDF, extracted in full).

  • REG-R44 — 금융감독원 「2024년 실손의료보험 사업실적(잠정)」: the same release as this file’s R8, retrieved through the KDI 경제교육·정보센터 mirror rather than the 보험연구원 reproduction, and cited beside R8 wherever a figure is load-bearing so the two independent retrievals corroborate. Retrieved: yes (7-page PDF, full text).

  • REG-R49 — 상법 제4편 제1장 통칙: 제649조, the right to terminate before a claim event and recover the 미경과보험료 — on a one-year contract with no surrender value, the whole of what a lapse returns. Retrieved: yes (제4편 read in full).

  • REG-R50 — 상법 제4편 제3장 인보험: cited to record that the 인보험 suicide provisions have no benefit to withhold on a contract that pays nothing on death, and for the 치료비 exclusions that already net off 자동차보험 and 산재보험 recoveries. Retrieved: yes.

  • REG-R51 — 금융소비자보호법 제46조 (청약의 철회): the statutory cooling-off — 15 days from receipt of the 보험증권, never later than 30 from application, effective on despatch — that the 표준약관 implements verbatim, and the bar on withdrawal after a claim event. Retrieved: yes.

  • REG-R52 — 예금자보호법 시행령 제18조: ₩100,000,000 per person per insurer on 보험금, in a bucket separate from retirement-pension and 연금저축 claims. Cited here for a structural point: the 해약환급금 leg of that bucket is empty on this contract. Retrieved: yes.

  • REG-R53 — 국민건강보험법 제41조·제42조·제44조: the 요양급여 list, the 요양기관 tiers and the 본인일부부담금 — the definition of the 급여 half of the insured loss and the footing of the 본인부담상한제 that truncates it. Retrieved: yes (98,719 characters).

  • REG-R54 — 노인장기요양보험법 제2조·제15조 등: the 장기요양 등급 판정 whose 1·2등급 holders are exempt from the 비급여 experience rating — the only direct statutory cross-reference between this model and LTC_KR_S, and part of what reld_exempt_share stands for. Retrieved: yes (133,932 characters).

  • REG-R57 — 소득세법 제59조의4 (보장성보험료): the 12% credit on up to ₩1,000,000 of premium a year; on the anchor’s ₩143,784 the credit is capped by the premium, not the ceiling. Retrieved: yes.

  • REG-R60 — 한국회계기준원, K-IFRS 제1117호: the standard mandatory in Korea since 2023-01-01, not voluntary as in Japan, which is why the contract-boundary question on a one-year renewable is live rather than academic here. Retrieved: in part — the release body returned, the 별첨 HWP carrying the standard’s own text did not, so the boundary readings the documents publish both of are unverified at instrument level.

  • REG-R61 — 보험개발원 「장기손해보험 참조순보험요율」 공시: the published morbidity reference rates — a cancer incidence grid and a 질병입원율 grid. The latter is available as an external anchor for the age slope of adm_rate and is deliberately not used for the level, being a fixed-benefit insured-event rate on a net-premium footing rather than an indemnity claim frequency. Retrieved: yes.

  • REG-R62 — 손해보험협회 공시실 / e-보험시장 (kpub.knia.or.kr): the portal through which [S6] and [S7] were reached, named in the documents because attributing a 손해보험 product disclosure to the 생명보험협회 would be wrong and because its POST-driven grids are where two of this product’s gaps sit. Retrieved: in part — landing pages rendered; the comparison grids did not.

Provenance note#

Every entry above traces to _research/indemnity-medical.md, which is the citation ground truth for this product: the S# and R# numbering used here is that file’s numbering, unchanged, and it is never renumbered because these documents cite against it. The research file’s own numbering is not this one’s — it runs to S7 and R20 and carries R18, which this file omits as uncited, with the reason given at the head of this page. The [REG-R#] scheme is a third, separate numbering, frozen at R1–R62 in references/regulatory-and-actuarial-references.md.

What lives in the research file and not here: the eighteen-section fact extraction — which figure came from which page of which release, the generation-by-generation co-payment and deductible tables, the full 요율 상대도 worked example, the in-force and loss-ratio series by generation, and the claim mix by treatment category and provider class; the variation-across-carriers table; the decoding routes that made the HWP files readable at all; and the register of fetch failures.

The gaps register, restated because it decides what is std in this product. No Korean 실손 morbidity or severity basis is published in any form — the 참조순보험요율 does not cover the line R20 REG-R61 and the 산출방법서 is never disclosed REG-R2 — so every frequency, severity, persistency and expense parameter is a construction on aggregate experience. No age × sex premium scale for 4세대 or 5세대 was obtained: [S6]’s and [S7]’s grids are client-side or POST-driven and returned nothing to a plain fetcher, so nine of the ten model point premiums are std and only the anchor’s ₩11,982 is published R1. No 상품요약서 with a 사업비 disclosure was obtained for any generation, so the 6 / 7 / 3 expense split is a std decomposition of one published 16.1% aggregate R7. The current 보험업감독규정 제7-63조제2항 was not retrieved from the 국가법령정보센터 route R19; it is carried by REG-R17, retrieved in full, and its 제6호가목 text by the verbatim quotation in R12. The K-IFRS 1117 standard text did not extract REG-R60, so the contract-boundary readings this product publishes both of are unverified at instrument level. And the single-year 완전생명표 qx tables live behind KOSIS and were not downloaded REG-R39, which with the unpublished 제10회 경험생명표 REG-R33 is why mort_table.csv is a Makeham fit to four published summary statistics REG-R38 rather than a table.

Two entries were read through a reproduction rather than from the publisher: R8, the 2024 사업실적, through 보험연구원’s 「주간 트렌드」 republication — corroborated by REG-R44, which reached the same release through a different mirror — and R9, likewise through 보험연구원, with its underlying survey retrieved directly as REG-R41. Both routes are recorded at the entries rather than hidden, and in both cases a second independent retrieval of the same content exists in the cross-product library.

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