1. The defendant's appeal is dismissed.

2. The costs of appeal shall be borne by the Defendant.

Purport of claim and appeal

1...

1. Basic facts

가. 원고는 피고와 사이에 피보험자는 원고의 자녀인 B으로, 보험기간은 2008. 12. 19.부터 2022. 12. 19.까지로 정하여 질병입원의료비를 1년 및 1사고당 50,000,000원을 한도로 담보하는 등의 내용으로 무배당굿앤굿어린이CI보험계약(이하 ‘이 사건 보험계약’이라 한다)을 체결하였다.

B. The main contents of the terms and conditions that guarantee the insurance contract of this case for disease, hospitalization and medical expenses (e.g., renewed) (hereinafter “instant terms and conditions”) are as follows.

Article 1 (Compensation for Loss) (1) Where the insured has received treatment by being hospitalized in a hospital or a clinic due to a disease (excluding cases where he/she has received diagnosis or treatment due to such disease within the past five years from the date of subscription for an insurance contract) during the insurance period of this special contract entered in the insurance policy (insurance policy), the company shall pay the following expenses for hospitalization of a disease according to this special agreement:

1. Hospitalization fees: Medical examination fees, standard sick room usage fees, patient care fees, and food expenses;

2. Expenses for hospitalization: Testing fees, radiation fees, medication and prescription fees, the main feed, secondary feed, medical treatment fees, mental therapy fees, materials for treatment, gners, and designated medical treatment fees;

3. Expenses for surgery: Expenses for surgery, anesthesia and materials for surgery;

4. Sick difference: Difference between the actual user's disease room and the standard disease room. (2) The company shall compensate for the full amount of the expenses under paragraph (1) 1, 2, and 3 (referring to the principal's share and the non-benefit part among the health care benefit prescribed by the National Health Insurance Act) and 50% of the expenses under paragraph (1) 4 to be borne by the insured under the National Health Insurance Act within the limit of the compensation limit under this special agreement entered in the insurance policy (insurance policy) per accident.

However, if the insured is not subject to the national health insurance (including the case of the insured without undergoing the medical care benefits procedure prescribed by the National Health Insurance Act), the amount equivalent to 40% of the total medical expenses for hospitalization of disease under paragraph (1) shall be one accident.