1. The plaintiff's appeal is dismissed.

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

Purport of claim and appeal

The first instance court.

1. Basic facts

A. On June 26, 2011, the Plaintiff entered into an insurance contract “integrated universal life insurance 1.0 (Free Distribution)” (hereinafter “instant insurance contract”) with the insured as the Plaintiff, which added a special agreement to guarantee lost health (hereinafter “instant special agreement”) with the Defendant as the Plaintiff.

B. Of the insurance terms and conditions of the instant insurance contract, the main contents of the instant special agreement (hereinafter “instant special agreement”) are as follows.

(밑줄은 이 사건과 관련된 중요 부분을 표시함). 《상해입원형》 제3조【보상내용】 회사는 이 특약의 보험기간 중 피보험자(보험대상자)가 상해로 인하여 병원에 입원하여 치료를 받은 경우에는 입원의료비를 다음과 같이 하나의 상해당 각각 보험가입금액(5,000만 원)을 한도로 보상합니다.

Article 4 of the Medical Care Assistance Act provides that the amount of compensation shall be calculated by deducting 50% of the difference between the actual costs of the sick room and the standard sick room (if the amount equivalent to 10% exceeds 2,00,000 won per annum from the contract date or from the contract date of each year, the amount in excess shall be compensated) from the total sum of the amount of the patient's compensation, the expenses for hospitalization, the medical care benefits prescribed in the National Health Insurance Act, or the medical care benefits prescribed in the Medical Care Assistance Act (excluding the difference between the actual costs of the sick room and the standard sick room at the time of hospitalization), and the amount after deducting 50,000 of the difference between the actual costs of the sick room and the standard sick room (Provided, That the amount shall be limited to 1,00,000 won per day; the average amount per day shall be calculated by dividing the difference between the average costs of the superior sick room during the period of hospitalization by the total days of hospitalization)

6. Expenses incurred in the purchase and replacement of medical treatment materials, such as artificial organs or parts, artificial organs, artificial organs, or parts, and in performing functions instead of their functions, such as artificial organs or parts, etc.;