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1. The part of the judgment of the court of first instance against the plaintiff, which orders payment below, shall be revoked.
The defendant.
Reasons
1. Basic facts
A. On March 26, 2015, the Plaintiff’s wife B entered into the instant insurance contract with the Defendant as the insured (hereinafter “instant insurance contract”). According to the special agreement on the guarantee of actual medical expenses (type of disease hospitalization/elective type; hereinafter “instant contract”) contained in the instant insurance contract, the Defendant is obliged to pay 90% of the sum of the “personal charges” and “non-paid benefits (excluding the difference of the medical expenses for injury and disease)” among the medical expenses prescribed in the National Health Insurance Act and the “non-paid benefits (excluding the difference of the medical expenses for injury and disease)” under the Medical Care Assistance Act if the Plaintiff was hospitalized in the hospital and received medical treatment from the hospital, within ten business days from the date on which the claim for the insurance money is filed.
B. Meanwhile, Article 4(3) of the Terms and Conditions of this case provides that the following medical expenses shall not be compensated:
Article 4 [Matters not to be compensated] (3) Company shall not compensate for the following hospital medical expenses:
8. Medical expenses incurred in treating mothers for the purpose of improving their appearance;
(a) Poppy surgery, co-malopic surgery, crypology surgery, refluoral enlargement surgery, local inhalement surgery, salpopic removal surgery, etc.;
(e) Treatment for improvement of appearance, which falls under the health insurance non-payment;
C. In addition, Article 41(3) of the former National Health Insurance Act (amended by Act No. 13985, Feb. 3, 2016) provides that “The Minister of Health and Welfare may exclude a disease that does not interfere with business or daily life in setting the criteria for medical care benefits under paragraph (2) and other matters prescribed by Ordinance of the Ministry of Health and Welfare from the eligibility for medical care benefits.” Article 9(1) of the former Rules on the criteria for medical care benefits for national health insurance (amended by Ordinance of the Ministry of Health and Welfare, No. 316, May 29, 2015) provides that “The matters excluded from the eligibility for medical care benefits under Article 41(3) of the Act (hereinafter referred to as “non-beneficiary”) are as specified in attached Table