[흥국화재] * 갱신형 담보를 포함하는 상품의 갱신 담보 가입시에는 보험료가 변동될 수 있습니다. (p30-49)

Ⅵ. 보험용어 해설
해약환급금
ㆍ계약의 효력 상실 또는 해지시 보험계약자에게 돌려주는 금액으로 아래와 같음
구분
납입기간 중
납입기간 후
1종 1형(해약환급금 지급형)
2종 1형(20년갱신형)
2종 2형(30년갱신형)
계약자적립액에서 해약공제액
(미상각 신계약비)을
차감한 금액
해약환급금
1종 2형
(납입후
해약환급금지급형의 50%지급형)
없음
1종 1형
(해약환급금 지급형)
해약환급금의 50%
2종 3형
(30년갱신형)
없음
없음
ㆍ해약공제액(미상각 신계약비) : 신계약을 청약하고 승낙하는 과정에서 소요되는 비용을
계약체결비용이라 하며, 일정기간 동안 보험료에서 균등하게 공제함. 그러나 계약을 중도에
해지하게 될 경우, 공제하지 못한 계약체결비용을 한꺼번에 공제하게 되는데 이를 해약공제액
(미상각 신계약비)라 함
ㆍ해약환급금
= 보장부분 해약환급금 + 적립부분 해약환급금(1종(세만기형) 1형, 2종(갱신형) 1형, 2형에
한함)
30

- 31 -
목 차
흥국화재 약관 이용 Guide Book
시각화 된 흥국화재 약관 요약서
Ⅰ. 보험계약의 개요 ····························································································································· 8
Ⅱ. 소비자가 반드시 알아두어야 할 유의사항 ······················································································ 11
Ⅲ. 보험계약의 일반사항 ····················································································································· 16
Ⅳ. 보험금 청구 및 지급절차 안내 ······································································································ 20
Ⅴ. 자주 발생하는 민원 예상 ·············································································································· 26
Ⅵ. 보험용어 해설 ······························································································································ 29
보 통 약 관
제1관 목적 및 용어의 정의 ················································································································· 40
제1조(목적) ···································································································································· 40
제2조(용어의 정의) ························································································································· 40
제2관 보험금의 지급 ·························································································································· 42
제3조(보험금의 지급사유) ··············································································································· 42
제4조(「암」,「갑상선암」 및 「기타피부암」의 정의 및 진단 확정) ··············································· 42
제5조(보험금 지급에 관한 세부규정) ······························································································· 43
제6조(보험금을 지급하지 않는 사유) ······························································································· 44
제7조(보험금 지급사유의 통지) ······································································································· 44
제8조(보험금 등의 청구) ················································································································· 44
제9조(보험금 등의 지급절차) ·········································································································· 45
제10조(중도인출) ···························································································································· 46
제11조(공시이율의 적용 및 공시) ···································································································· 46
제12조(만기환급금의 지급) ············································································································· 47
제13조(보험금 받는 방법의 변경) ···································································································· 47
제14조(주소변경통지) ····················································································································· 48
제15조(보험수익자의 지정) ············································································································· 48
제16조(대표자의 지정) ···················································································································· 48
제3관 계약자의 계약 전 알릴 의무 등 ································································································ 49
제17조(계약 전 알릴 의무) ············································································································· 49
제18조(알릴 의무 위반의 효과) ······································································································· 49
제19조(사기에 의한 계약) ··············································································································· 50
제4관 보험계약의 성립과 유지 ············································································································ 50
제20조(보험계약의 성립) ················································································································· 50
제21조(청약의 철회) ······················································································································· 51

- 32 -
제22조(약관 교부 및 설명의무 등) ·································································································· 51
제23조(계약의 무효) ······················································································································· 53
제24조(계약내용의 변경 등) ············································································································ 53
제25조(보험나이 등) ······················································································································· 54
제26조(보통약관 계약의 소멸) ········································································································ 55
제26조의2(계약의 소멸시 계약자적립액의 청구) ·············································································· 55
제27조(계약의 자동갱신) ················································································································· 55
제5관 보험료의 납입 ·························································································································· 56
제28조(제1회 보험료 및 회사의 보장개시) ······················································································ 56
제29조(갱신계약 제1회 보험료의 납입연체와 계약의 해제) ······························································ 57
제30조(제2회 이후 보험료의 납입) ·································································································· 57
제31조(보험료 납입면제) ················································································································· 57
제32조(보험료 납입면제에 관한 세부규정) ······················································································· 58
제33조(보험료의 자동대출납입) ······································································································· 60
제34조(보험료의 납입이 연체되는 경우 납입최고(독촉)와 계약의 해지) ············································ 60
제35조(보험료의 납입을 연체하여 해지된 계약의 부활(효력회복)) ···················································· 61
제36조(강제집행 등으로 인하여 해지된 계약의 특별부활(효력회복)) ················································· 62
제6관 계약의 해지 및 해약환급금 등 ·································································································· 62
제37조(계약자의 임의해지 및 피보험자의 서면동의 철회) ································································ 62
제37조의2(위법계약의 해지) ··········································································································· 62
제38조(중대사유로 인한 해지) ········································································································ 63
제39조(회사의 파산선고와 해지) ····································································································· 63
제40조(해약환급금) ························································································································· 63
제41조(보험계약대출) ····················································································································· 64
제42조(배당금의 지급) ···················································································································· 64
제7관 분쟁의 조정 등 ························································································································· 64
제43조(분쟁의 조정) ······················································································································· 64
제44조(관할법원) ···························································································································· 65
제45조(소멸시효) ···························································································································· 65
제46조(약관의 해석) ······················································································································· 65
제47조(설명서 교부 및 보험안내자료 등의 효력) ············································································· 65
제48조(회사의 손해배상책임) ·········································································································· 65
제49조(개인정보보호) ····················································································································· 66
제50조(준거법) ······························································································································· 66
제51조(예금보험에 의한 지급보장) ·································································································· 66

- 33 -
※ 가입하신 갱신형 주기에 따라 아래 특별약관 명칭에 (갱신형_20년) 또는 (갱신형_30년)이 추가로 기
재됩니다.
※ 단, 항암양성자방사선치료비Ⅱ, 항암세기조절방사선치료비Ⅱ, 항암세기조절방사선치료비(토모테라피)
Ⅱ, 항암정위방사선치료비Ⅱ, 표적항암약물허가치료비Ⅱ, 표적항암약물허가치료비Ⅱ(연간1회한), 항
암호르몬약물허가치료비(기타피부암 및 갑상선암이외의 암)Ⅱ, 갑상선암호르몬약물허가치료비Ⅱ, 카
티(CAR-T) 항암약물허가치료비(연간1회한), 특정유방병변 진공보조장치이용절제치료비(최초1회한),
고강도초음파집속술(HIFU) 치료비(특정부인과질환)(최초1회한), 특정중등도자궁경부이형성증진단비,
특정경도이상자궁경부이형성증진단비, 다빈치및레보아이로봇 암수술비(최초1회한), 다빈치로봇 특정
수술비(연간1회한), 자궁 및 난소 특정질환 로봇수술비(연간1회한), 암 MRI검사지원비(급여_연간1회
한) 및 암 PET검사지원비(급여_연간1회한), 특정면역항암약물허가치료비(연간1회한)(갱신형_10년),
항암중입자방사선치료비 특별약관의 경우 가입하신 갱신형 주기와 상관 없이 (갱신형_10년)이 추가
로 기재됩니다.
특 별 약 관
제1장. 상해관련 특별약관 ··················································································································· 68
1. 일반상해후유장해(3~100%) 특별약관 ························································································· 68
2. 일반상해후유장해(80%이상) 특별약관 ························································································· 71
3. 일반상해사망 특별약관 ··············································································································· 74
제2장. 질병관련 특별약관 ··················································································································· 78
1. 질병후유장해(3~100%)(감액없음) 특별약관 ················································································ 78
2. 질병후유장해(80%이상)(감액없음) 특별약관 ················································································ 79
3. 암후유장해(3~100%)(감액없음) 특별약관 ···················································································· 81
4. 암사망(감액없음) 특별약관 ········································································································· 84
5. 신통합암(전이포함)진단비Ⅱ(유사암제외) 특별약관 ······································································ 86
6. 신통합암(전이포함)진단비Ⅱ(유사암제외)(면책없음,감액없음) 특별약관 ········································· 94
7. 신통합암(원발후전이포함)진단비Ⅱ(유사암제외) 특별약관 ··························································· 101
8. 신통합암(원발후전이포함)진단비Ⅱ(유사암제외)(면책없음,감액없음) 특별약관 ······························ 109
9. 암진단비(유사암제외) 특별약관 ································································································· 115
10. 암진단비(유사암제외)(면책없음,감액없음) 특별약관 ·································································· 117
11. 유사암진단비 특별약관 ··········································································································· 119
12. 유사암진단비(감액없음) 특별약관 ···························································································· 121
13. 암진단비(소액암 및 유사암제외)(감액없음) 특별약관 ······························································· 122
14. 암진단비(소액암 및 유사암제외)(면책없음,감액없음) 특별약관 ················································· 125
15. 암진단비(유방암 및 유사암제외)(면책없음,감액없음) 특별약관 ················································· 127
16. 암진단정기검진비(10년)(6개월지급형) 특별약관 ······································································· 129
17. 암진단(유사암제외)정기검진비(10년)(6개월지급형) 특별약관 ···················································· 132
18. 11대특정암진단비(감액없음) 특별약관 ····················································································· 134
19. 고액치료비암진단비(감액없음) 특별약관 ·················································································· 136
20. 갑상선암(초기제외)진단비 특별약관 ························································································· 138
21. 재진단암진단비 특별약관 ········································································································ 140
22. 재진단암Ⅲ진단비 특별약관 ····································································································· 147
23. 전이암진단비 특별약관 ··········································································································· 153

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24. 재발암 및 잔여암진단비(2년대기형)(감액없음) 특별약관 ·························································· 156
25. 항암방사선치료후 9대합병증진단비 특별약관 ··········································································· 161
26. 신통합항암방사선약물치료비Ⅱ(유사암제외) 특별약관 ······························································· 165
27. 신통합항암방사선약물치료비Ⅱ(유사암제외)(면책없음,감액없음) 특별약관 ································· 173
28. 항암방사선치료비(치료당) 특별약관 ························································································· 179
29. 중증갑상선암진단비(감액없음) 특별약관 ·················································································· 181
30. 항암방사선약물치료비 특별약관 ······························································································ 183
31. 항암방사선약물치료비(면책없음,감액없음) 특별약관 ································································· 186
32. 항암방사선약물치료비(연간1회한) 특별약관 ············································································· 188
33. 항암양성자방사선치료비Ⅱ 특별약관 ························································································ 191
34. 항암세기조절방사선치료비Ⅱ 특별약관 ····················································································· 194
35. 항암세기조절방사선치료비(토모테라피)Ⅱ 특별약관 ·································································· 197
36. 항암정위방사선치료비Ⅱ 특별약관 ··························································································· 200
37. 표적항암약물허가치료비Ⅱ 특별약관 ························································································ 204
38. 표적항암약물허가치료비Ⅱ(연간1회한) 특별약관 ······································································· 208
39. 항암호르몬약물허가치료비(기타피부암 및 갑상선암이외의 암)Ⅱ 특별약관 ································ 214
40. 갑상선암호르몬약물허가치료비Ⅱ 특별약관 ·············································································· 218
41. 카티(CAR-T) 항암약물허가치료비(연간1회한) 특별약관 ··························································· 223
42. 특정면역항암약물허가치료비(연간1회한)(갱신형_10년) 특별약관 ··············································· 228
43. 항암방사선치료비 특별약관 ····································································································· 234
44. 항암약물치료비 특별약관 ········································································································ 237
45. 말기암 호스피스 완화의료병동 입원치료비(최초1회한) 특별약관 ·············································· 240
46. 양성뇌종양진단비 특별약관 ····································································································· 243
47. 크론병 및 궤양성대장염진단비 특별약관 ················································································· 244
48. 갑상선기능항진증치료비 특별약관 ··························································································· 246
49. 특정유방병변 진공보조장치이용절제치료비(최초1회한) 특별약관 ·············································· 248
50. 고강도초음파집속술(HIFU) 치료비(특정부인과질환)(최초1회한) 특별약관 ·································· 250
51. 갑상선 바늘생검 조직병리진단비(급여_연간1회한) 특별약관 ····················································· 252
52. 유방 바늘생검 조직병리진단비(급여_연간1회한) 특별약관 ························································ 254
53. 전립선 바늘생검 조직병리진단비(급여_연간1회한) 특별약관 ····················································· 257
54. 심부 바늘생검 조직병리진단비(급여_연간1회한) 특별약관 ························································ 259
55. 자궁 생검 조직병리진단비(급여_연간1회한) 특별약관 ······························································ 261
56. 특정4대질환 헬리코박터제균치료비(최초1회한) 특별약관 ························································· 263
57. 특정갑상선기능저하증진단비(선천성 제외) 특별약관 ································································ 265
58. 특정중등도자궁경부이형성증진단비 특별약관 ··········································································· 266
59. 질병입원비(1일-180일) 특별약관 ···························································································· 269
60. 질병입원비(1일-210일) 특별약관 ···························································································· 270
61. 질병입원비(요양,정신,한방병원제외)(181일이상) 특별약관 ························································ 272
62. 질병중환자실입원비(1일-180일) 특별약관 ··············································································· 274
63. 질병수술동반입원비(1일-20일) 특별약관 ················································································· 276
64. 암수술동반입원비(상급종합병원)(1일-20일) 특별약관 ······························································ 281
65. 간병인사용 질병입원비(요양병원제외)(1일당8시간이상)(1일-180일) 특별약관 ··························· 288
66. 간병인사용 질병입원비(요양병원)(1일-180일) 특별약관 ··························································· 292
67. 간병인사용 질병입원비(요양,정신,한방병원제외)(1일당8시간이상)(181일이상) 특별약관 ············ 295
68. 간호·간병통합서비스사용 질병입원비(1일-180일) 특별약관 ······················································ 299
69. 간호·간병통합서비스사용 질병입원비(요양,정신,한방병원제외)(181일이상) 특별약관 ················· 303
70. 간병인사용 질병입원지원비(요양병원제외)(간병인비용연간200만원이상) 특별약관 ····················· 306

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71. 간병인사용 질병입원지원비(요양병원)(간병인비용연간200만원이상) 특별약관 ··························· 312
72. 간호·간병통합서비스사용 질병입원비(1일-60일) 특별약관 ························································ 318
73. 간호·간병통합서비스사용 질병입원비(종합병원)(1일-60일) 특별약관 ········································ 321
74. 간호·간병통합서비스사용 질병입원비(상급종합병원)(1일-60일) 특별약관 ·································· 325
75. 암직접치료입원비(요양병원제외)(1일-180일) 특별약관 ····························································· 328
76. 암직접치료입원비(요양병원제외)(1일-210일) 특별약관 ····························································· 332
77. 요양병원 암입원비(1일-90일) 특별약관 ··················································································· 336
78. 암직접치료 종합병원입원비(1일-180일) 특별약관 ···································································· 340
79. 암직접치료 상급종합병원입원비(1일-180일) 특별약관 ····························································· 345
80. 암(유사암포함)중환자실입원비(1일-30일) 특별약관 ·································································· 349
81. 암직접치료통원비(연간30회한)(감액없음) 특별약관 ·································································· 353
82. 암직접치료 종합병원통원비(연간30회한)(감액없음) 특별약관 ···················································· 356
83. 암직접치료 상급종합병원통원비(연간30회한)(감액없음) 특별약관 ············································· 360
84. 질병수술비 특별약관 ·············································································································· 363
85. 질병수술비Ⅱ 특별약관 ··········································································································· 366
86. 8대기관 양성신생물(용종포함)수술비(연간1회한) 특별약관 ······················································· 369
87. 특정5대암 중증수술비(급여_최초1회한)(감액없음) 특별약관 ····················································· 371
88. 암수술비(유사암제외)(최초1회한)(감액없음) 특별약관 ······························································ 376
89. 암수술비(유사암제외)(감액없음) 특별약관 ················································································ 379
90. 암수술비(유사암제외)(25%체증형)(감액없음) 특별약관 ····························································· 383
91. 유사암수술비(감액없음) 특별약관 ···························································································· 386
92. 암1~5종수술비(수술당) 특별약관 ···························································································· 388
93. 암1~5종수술비(동일질병당) 특별약관 ······················································································ 393
94. 유방수술비(유방암,유방의제자리암) 특별약관 ··········································································· 397
95. 자궁적출수술비(여성생식기암,여성생식기의제자리암) 특별약관 ················································· 401
96. 다빈치및레보아이로봇 암수술비(최초1회한) 특별약관 ······························································ 404
97. 다빈치로봇 특정수술비(연간1회한) 특별약관 ··········································································· 409
98. 자궁 및 난소 특정질환 로봇수술비(연간1회한) 특별약관 ·························································· 411
99. 암 MRI검사지원비(급여_연간1회한) 특별약관 ··········································································· 415
100. 암 PET검사지원비(급여_연간1회한) 특별약관 ········································································ 418
101. 암직접치료통원비(연간10회한)(감액없음) 특별약관 ································································ 420
102. 암직접치료 종합병원통원비(연간10회한)(감액없음) 특별약관 ·················································· 424
103. 암직접치료 상급종합병원통원비(연간10회한)(감액없음) 특별약관 ··········································· 427
104. 특정경도이상자궁경부이형성증진단비 특별약관 ······································································ 431
105. 특정NGS유전자패널검사지원비(급여_연간1회한) 특별약관 ······················································ 433
106. 중증질환자(신규암(유사암제외)) 산정특례대상보장 특별약관 ·················································· 436
107. 중증질환자(중복암 및 재등록암) 산정특례대상보장(감액없음) 특별약관 ·································· 441
108. 대장용종제거수술비(급여,용종개수당) 특별약관 ····································································· 446
109. 보험료납입지원보장(유사암진단) 특별약관 ············································································· 448
110. 중증질환자(신규암(유사암)) 산정특례대상보장 특별약관 ························································· 450
111. 암주요치료비(유사암제외)(연간1회한,진단후10년)(감액없음) 특별약관 ···································· 454
112. 암주요치료비(유사암)(연간1회한, 진단후10년)(감액없음) 특별약관 ········································· 459
113. 종합병원 1인실(특실포함) 질병입원비(1일-30일) 특별약관 ···················································· 463
114. 상급종합병원 1인실(특실포함) 질병입원비(1일-30일) 특별약관 ·············································· 466
115. 종합병원 2~3인실 질병입원비(1일-30일) 특별약관 ······························································· 468
116. 상급종합병원 2~3인실 질병입원비(1일-30일) 특별약관 ························································· 471
117. 종합병원 질병수술비 특별약관 ······························································································ 474

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118. 상급종합병원 질병수술비 특별약관 ························································································ 477
119. 전신마취암수술비(감액없음) 특별약관 ··················································································· 480
120. 신재진단암진단비Ⅱ(기타피부암,갑상선암 및 전립선암 포함, 5회한) 특별약관 ························ 485
121. 상급종합병원(국립암센터 및 원자력병원포함) 암주요치료비(유사암제외)(연간1회한,진단후10년)
(감액없음) 특별약관 ············································································································· 491
122. 상급종합병원(국립암센터 및 원자력병원포함) 암주요치료비(유사암)(연간1회한,진단후10년)
(감액없음) 특별약관 ············································································································· 496
123. 질병수술비(특정6대질병Ⅱ제외) 특별약관 ·············································································· 501
124. 상급종합병원 질병수술비(특정6대질병Ⅱ제외) 특별약관 ························································· 504
125. 질병수술비(특정8대질병제외) 특별약관 ·················································································· 507
126. 비급여 암주요치료비(전액본인부담포함,연간1회한,진단후10년)(감액없음) 특별약관 ················· 510
127. 비급여 항암약물치료비(전액본인부담포함,연간1회한,진단후10년)(감액없음) 특별약관 ·············· 515
128. 항암중입자방사선치료비 특별약관 ························································································· 520
129. 간병인사용 질병입원비(종합병원)(1일-180일) 특별약관 ························································· 523
130. 간병인사용 질병입원비(상급종합병원)(1일-180일) 특별약관 ··················································· 527
131. 암주요치료비Ⅱ(유사암제외)(치료별 연간1회한)(감액없음) 특별약관 ········································ 531
132. 암주요치료비Ⅱ(유사암)(치료별 연간1회한)(감액없음) 특별약관 ·············································· 538
133. 암주요치료비Ⅱ(유사암제외)(연간1회한,진단후10년)(감액없음) 특별약관 ································· 543
134. 암주요치료비Ⅱ(유사암)(연간1회한,진단후10년)(감액없음) 특별약관 ········································ 549
135. 상급종합병원Ⅱ 암주요치료비Ⅱ(유사암제외)(치료별 연간1회한)(감액없음) 특별약관 ··············· 554
136. 상급종합병원Ⅱ 암주요치료비Ⅱ(유사암)(치료별 연간1회한)(감액없음) 특별약관 ······················ 560
137. 상급종합병원(국립암센터 및 원자력병원포함) 암주요치료비Ⅱ(유사암제외)
(연간1회한,진단후10년)(감액없음) 특별약관 ·········································································· 565
138. 상급종합병원(국립암센터 및 원자력병원포함) 암주요치료비Ⅱ(유사암)(연간1회한,진단후10년)
(감액없음) 특별약관 ············································································································· 571
139. 비급여 암주요치료비(전액본인부담포함,연간1회한)(감액없음) 특별약관 ·································· 576
140. 암진단비(유사암제외)(5회지급형) 특별약관 ············································································ 582
제3장. 상해 및 질병관련 특별약관 ···································································································· 589
1. 보험료 납입면제대상보장(암진단(유사암제외) 및 상해·질병후유장해(80%이상)) 특별약관 ············ 589
2. 응급실내원비(응급) 특별약관 ···································································································· 592
3. 가정간호치료비(급여_연간20회한) 특별약관 ··············································································· 593
4. 상급종합병원 가정간호치료비(급여_연간20회한) 특별약관 ·························································· 595
제4장. 제도성 특별약관 ···················································································································· 596
1. 특정 신체부위ㆍ질병 보장제한부 인수 특별약관 ········································································ 596
2. 선지급서비스 특별약관 ············································································································· 600
3. 보험료 자동납입 특별약관 ········································································································ 601
4. 이륜자동차 운전중(탑승포함)상해 부담보 특별약관 ···································································· 602
5. 보장보험료 납입면제 특별약관 ·································································································· 603
6. 특별조건부(할증보험료법 / 보험금감액법) 특별약관 ·································································· 604
7. 보험금대리청구인 지정서비스 특별약관 ····················································································· 605
8. 장애인전용보험 전환 특별약관 ·································································································· 606
9. 전자서명 특별약관 ··················································································································· 609
별 표

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【별표1】장해 분류표 ························································································································· 611
【별표2】기타관계법령 ······················································································································· 631
【별표3】보험금을 지급할 때의 적립이율 계산 ···················································································· 667
【별표4】악성신생물(암) 분류표 ·········································································································· 668
【별표5】제자리신생물 분류표 ············································································································ 669
【별표6】행동양식 불명 또는 미상의 신생물 분류표 ············································································ 670
【별표7】11대특정암 분류표 ··············································································································· 671
【별표8】고액치료비암 분류표 ············································································································ 673
【별표9】갑상선의 악성신생물(암) 분류표 ··························································································· 674
【별표10-1】항암방사선치료(급여) 분류표 ·························································································· 675
【별표10-2】항암약물(급여) 분류표 ···································································································· 677
【별표11-1】카티(CAR-T) 보장 대상 암 분류표 ················································································· 678
【별표11-2】카티치료제 해당 의약품명 및 성분명 분류표 ··································································· 679
【별표12】특정면역항암제 해당 의약품명 및 성분명 분류표 ································································ 680
【별표13】전신마취 의료행위 분류표 ·································································································· 682
【별표14】특정6대질병Ⅱ 분류표 ········································································································ 683
【별표15】특정8대질병 분류표 ············································································································ 684
【별표16】크론병 및 궤양성대장염 분류표 ·························································································· 685
【별표17】갑상선기능항진증 분류표 ···································································································· 686
【별표18】특정유방질환 분류표 ·········································································································· 687
【별표19-1】특정부인과질환 분류표 ··································································································· 688
【별표19-2】고강도초음파집속술(HIFU) 분류표 ··················································································· 689
【별표20】갑상선 바늘생검 조직병리진단(급여) 분류표 ······································································· 690
【별표21】유방 바늘생검 조직병리진단(급여) 분류표 ··········································································· 691
【별표22】전립선 바늘생검 조직병리진단(급여) 분류표 ······································································· 692
【별표23】특정4대질환 분류표 ············································································································ 693
【별표24】특정갑상선기능저하증(선천성 제외) 분류표 ········································································· 694
【별표25】특정중등도이상자궁경부이형성증 분류표 ············································································· 695
【별표26-1】8대기관 양성신생물 분류표 ···························································································· 696
【별표26-2】8대기관 양성신생물(용종포함) 수술(급여) 분류표 ···························································· 697
【별표27】1~5종수술 분류표 ·············································································································· 700
【별표28-1】유방암 분류표 ················································································································ 705
【별표28-2】유방의 제자리신생물 분류표 ··························································································· 706
【별표28-3】유방암 및 유방의 제자리암으로 인한 유방수술 분류표 ···················································· 707
【별표29-1】여성생식기암 분류표 ······································································································ 708
【별표29-2】여성생식기의 제자리신생물 분류표 ················································································· 709
【별표29-3】여성생식기암 및 여성생식기의 제자리암으로 인한 자궁적출수술 분류표 ·························· 710
【별표30-1】다빈치로봇 암수술 분류표 ······························································································ 711
【별표30-2】레보아이로봇 암수술 분류표 ··························································································· 711
【별표31】다빈치로봇을 이용한 특정수술 분류표 ················································································ 712
【별표32-1】자궁 및 난소 특정질환 분류표 ························································································ 713
【별표32-2】로봇수술 분류표 ············································································································· 714
【별표33】급여촬영 분류표 ················································································································· 715
【별표34】양전자 단층촬영(PET) 검사(급여) 분류표 ············································································ 724
【별표35】응급증상 및 이에 준하는 증상 ···························································································· 725
【별표36】가정간호치료(급여) 분류표 ································································································· 726

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【별표37】상급종합병원 가정간호치료(급여) 분류표 ············································································ 727
【별표38】특정경도이상자궁경부이형성증 분류표 ················································································ 728
【별표39】특정신체부위 분류표 ·········································································································· 729
【별표40】특정질병 분류표 ················································································································· 731
【별표41】급여 특정NGS유전자패널검사 분류표 ·················································································· 732
【별표42-1】중증질환자(암) 산정특례 대상질환 분류표 ······································································· 733
【별표42-2】중증질환자(암) 산정특례대상 분류표 ··············································································· 733
【별표42-3】특정소액암 분류표 ·········································································································· 734
【별표42-4】뇌·수막의 양성신생물 분류표 ·························································································· 734
【별표43】대장용종제거수술(급여) 분류표 ··························································································· 735
【별표44-1】특정5대암 분류표 ··········································································································· 736
【별표44-2】특정5대암 중증수술(급여) 분류표 ··················································································· 737
【별표45】전이암 분류표 ···················································································································· 741
【별표46】신통합암(전이포함)Ⅱ(유사암제외) 분류표 ··········································································· 742
【별표47-1】항암방사선치료후5대합병증 분류표 ················································································· 744
【별표47-2】항암방사선치료후4대합병증 분류표 ················································································· 745
【별표48】신통합암(원발후전이포함)Ⅱ(유사암제외)(원발암) 분류표 ······················································ 746
【별표49】신통합암(원발후전이포함)Ⅱ(유사암제외)(원발후전이) 분류표 ··············································· 748
【별표50】심부 바늘생검 조직병리진단(급여) 분류표 ··········································································· 749
【별표51】자궁 생검 병리진단(급여) 분류표 ························································································ 749
특별약관 색인

보 통 약 관
※ 보통약관은 계약자가 이 보험을 가입시 기본적으로 가입을 하여야 하는 약관을 말합니다.

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제1관 목적 및 용어의 정의
제1조(목적)
이 보험계약(이하 ‘계약’이라 합니다)은 보험계약자(이하 ‘계약자’라 합니다)와 보험회사(이하 ‘회사’라 합니
다) 사이에 피보험자의 상해, 질병, 비용손해 등에 대한 위험을 보장하기 위하여 체결됩니다.
제2조(용어의 정의)
이 계약에서 사용되는 용어의 정의는 이 계약의 다른 조항에서 달리 정의되지 않는 한 다음과 같습니다.
1. 계약관계 관련 용어
용 어
정 의
계약자
회사와 계약을 체결하고 보험료를 납입할 의무를 지는 사람을 말합니다.
보험수익자
회사에 보험금(신체손해 보장 및 비용손해보장의 지급사유가 발생하는 때에 한합
니다) 및 만기환급금을 청구하여 받을 수 있는 사람을 말합니다.
보험증권
계약의 성립과 그 내용을 증명하기 위하여 회사가 계약자에게 드리는 증서를 말합
니다.
진단계약
계약을 체결하기 위하여 피보험자가 건강진단을 받아야 하는 계약을 말합니다.
피보험자
보험사고의 대상이 되는 사람을 말합니다.
2. 지급사유 관련 용어
용 어
정 의
상해
보험기간 중에 발생한 급격하고도 우연한 외래의 사고로 신체(의수, 의족, 의안,
의치 등 신체보조장구는 제외하나, 인공장기나 부분 의치 등 신체에 이식되어 그
기능을 대신할 경우는 포함합니다)에 입은 상해를 말합니다.
장해
「장해분류표」(【별표1】참조)에서 정한 기준에 따른 장해상태를 말합니다.
신체
의수, 의족, 의안, 의치등 신체보조장구는 제외하나, 인공장기나 부분 의치등 신체
에 이식되어 그 기능을 대신한 경우는 포함합니다.
중요한 사항
계약 전 알릴 의무와 관련하여 회사가 그 사실을 알았더라면 계약의 청약을 거절
하거나 보험가입금액 한도 제한, 일부 보장 제외, 보험금 삭감, 보험료 할증과 같
이 조건부로 승낙하는 등 계약 승낙에 영향을 미칠 수 있는 사항을 말합니다.
보험가입금액
보험사고 발생시 보험회사가 지급하여야 할 보험금의 기준이 되는 금액으로 보험
증권에 기재된 금액을 말합니다.
한국표준질병
･사인분류
한국인의 질병 및 사인에 대하여 의무기록자료 및 사망원인통계조사(질병이환 및
사망자료)등의 표준 통계를 세계보건기구(WHO)의 국제질병분류 ICD를 기초로 그
성질의 유사성에 따라 체계적으로 유형화한 것을 말합니다.

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3. 지급금과 이자율 관련 용어
용 어
정 의
연단위 복리
회사가 지급할 금전에 이자를 줄 때 1년마다 마지막 날에 그 이자를 원금에 더한
금액을 다음 1년의 원금으로 하는 이자 계산방법을 말합니다.
예시) 연단위 복리 계산법
* 연이율 10%로 100원을 3년동안 부리시
→ [가입시] 100원(원금)
→ [1년후] 100원(원금) + 100원 × 10%(1년이자) = 총110원
→ [2년후] 100원(원금) + 100원 × 10%(1년이자)
+ [100원(원금) + 100원 × 10%] × 10% = 총121원
평균공시이율
전체 보험회사 공시이율의 평균으로, 이 계약 체결 시점의 이율을 말합니다. 이 평
균공시이율은
금융감독원
홈페이지(www.fss.or.kr)의「업무자료/보험업무」 내
「보험상품자료」에서 확인할 수 있습니다.
해약환급금
계약이 해지되는 때에 회사가 계약자에게 돌려주는 금액을 말합니다.
4. 기간과 날짜 관련 용어
용 어
정 의
보험기간
계약에 따라 보장을 받는 기간을 말합니다.
영업일
회사가 영업점에서 정상적으로 영업하는 날을 말하며, 토요일, ‘관공서의 공휴일에
관한 규정’에 따른 공휴일, 대체공휴일 및 노동절을 제외합니다.
※ 이와 연관된 법규는 【별표2】기타관계법령을 참조하시기 바랍니다.
5. 보험료 관련 용어
용 어
정 의
보험료
계약자가 계약에 의거하여 회사에 지급하여야 하는 금액을 말하며 보장보험료와
적립보험료로 구성됩니다.
보장보험료
손해를 보장하는데 필요한 보험료(보장부분에 해당하는 회사의 사업경비를 포함합
니다)를 말합니다.
적립보험료
회사가 적립한 금액을 돌려주는데 필요한 보험료(적립부분에 해당하는 회사의 사업
경비를 포함합니다)를 말합니다.
적립부분 순보험료
적립보험료에서 적립부분에 해당하는 회사의 사업경비를 공제한 보험료를 말합
니다.

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6.「갱신형」계약의 갱신관련 용어
용 어
정 의
최초계약
‘갱신형’계약이 최초로 부가되는 경우를 말합니다.
갱신계약
‘갱신형’계약의 보험기간이 끝난 후 해당 계약이 갱신 된 경우를 말합니다.
갱신일
‘갱신형’계약이 갱신되기 직전 계약의 보험기간이 끝난 날의 다음날을 말합니다.
제2관 보험금의 지급
제3조(보험금의 지급사유)
회사는 보험증권에 기재된 피보험자에게 다음의 경우에 해당되는 사유가 발생한 때에는 보험수익자에게 약
정한 보험금을 지급합니다.
1. 암후유장해(80%이상)보험금 : 보험기간 중에 제5조(보험금 지급에 관한 세부규정) 제1항 및 제2항에
서 정한 보장개시일 이후에 제4조(「암」,「갑상선암」 및 「기타피부암」의 정의 및 진단 확정)의
「암(갑상선암, 기타피부암 포함)」으로 진단이 확정되고 그 암(갑상선암, 기타피부암 포함)으로 인
하여 신체의 일부를 잃었거나 그 기능이 영구히 상실(이하 「후유장해」라고 합니다)되어 「장해분
류표」(【별표1】참조. 이하 같습니다)에서 정한 장해지급률이 80%이상에 해당하는 후유장해상태가
되었을 때에는 최초 1회에 한하여 아래의 금액을 지급

구 분
지 급 금 액
암후유장해(80%이상)보험금
이 보장의 보험가입금액
제4조(「암」,「갑상선암」 및 「기타피부암」의 정의 및 진단 확정)
① 이 보장에서 「암」, 「갑상선암」, 「기타피부암」이라 함은 제9차 한국표준질병･사인분류에 있어서
다음에 정한 질병을 말합니다.
1.「암」이라 함은 「악성신생물(암) 분류표」(【별표4】참조)에 해당하는 질병을 말합니다.
다만, 「악성신생물(암) 분류표」(【별표4】참조)에 해당하는 질병이라 할지라도 기타피부암(C44),
갑상선암(C73) 및 이들을 원발부위(최초 발생한 부위)로 하여 불명확한, 이차성 및 상세불명 부위의
악성신생물(암)(C77~C80)에
해당하는
경우이거나
전암(前癌)상태(암으로
변하기
이전상태,
Premalignant condition or condition with malignant potential)는 「암」에서 제외합니다.
[유의사항]
한국표준질병·사인분류 지침서의 "사망 및 질병이환의 분류번호부여를 위한 선정준칙과 지침"에 따라
C77~C80(불명확한, 이차성 및 상세불명 부위의 악성신생물(암)의 경우 일차성 악성신생물(암)이 확인
되는 경우에는 원발부위(최초 발생한 부위)를 기준으로 분류합니다.
다만, 이 경우에도 이차성 및 상세불명 부위의 악성신생물(암)(C77~C80)의 진단확정 시점은 원발암 진
단확정 시점으로 변경되지 않습니다.
<원발부위(최초 발생한 부위) 기준 예시>
‧ C73(갑상선의 악성신생물)이 림프절로 전이되어 C77(림프절의 이차성 및 상세불명의 악성신생물)로
진단된 경우에도 C73(갑상선의 악성신생물)에 해당하는 질병으로 봅니다.
‧ C50(유방의 악성 신생물)이 폐로 전이되어 C78.0(폐의 이차성 악성 신생물)로 진단된 경우에도 C50
(유방의 악성 신생물)에 해당하는 질병으로 봅니다.

- 43 -
2.「갑상선암」이라 함은 「악성신생물(암) 분류표」(【별표4】참조)에서 분류번호 C73(갑상선의 악성
신생물(암))에 해당하는 질병을 말합니다.
3.「기타피부암」이라 함은 「악성신생물(암) 분류표」(【별표4】참조)에서 분류번호 C44(기타 피부의
악성신생물(암))에 해당하는 질병을 말합니다.
②「암(갑상선암, 기타피부암 포함)」이라 함은 제1항의 「암」, 「갑상선암」 및 「기타피부암」을 포함한
암을 말합니다.
③「암」, 「갑상선암」, 「기타피부암」의 진단확정은 병리 또는 진단검사의학의 전문의 자격증을 가진
자에 의하여 내려져야 하며, 이 진단은 조직(fixed tissue)검사, 미세바늘흡인검사(fine needle
aspiration) 또는 혈액(hemic system)검사에 대한 현미경소견을 기초로 하여야 합니다. 이 경우 「암」,
「갑상선암」, 「기타피부암」의 진단확정 시점은 상기 검사에 의한 결과보고 시점으로 합니다.
④ 제3항에 따른 진단이 가능하지 않을 때에는 피보험자가 「암」, 「갑상선암」, 「기타피부암」으로 진
단 또는 치료를 받고 있음을 증명할 만한 문서화된 기록 또는 증거가 있어야 합니다.
<「제3항에 따른 진단이 가능하지 않을 때」 예시>
- 피보험자가 조직검사 등 병리학적 검사를 받을 여유없이 급속한 병증 악화로 사망한 경우
- 종양의 발생부위 및 피보험자의 신체상태 등의 이유로 조직을 추출하는 경우 생명의 위험을 초래할
수 있어 병리학적 검사를 시행할 수 없는 경우
제5조(보험금 지급에 관한 세부규정)
① 제3조(보험금의 지급사유) 암후유장해(80%이상)의 보장개시일은 다음 각 호를 따릅니다.
1. 최초계약의 경우 : 보험계약일부터 그 날을 포함하여 90일이 지난 날의 다음날
(단, 갑상선암, 기타피부암에 대한 보장개시일은 보험계약일로 합니다)
2. 갱신계약의 경우 : 이 특별약관의 갱신일
< 암후유장해(80%이상)의 보장개시일 >
(단, 갑상선암, 기타피부암은 제외, 최초계약에 한함)
계약일
보장개시일
90일
20XX년 4월 10일
20XX년 7월 9일
② 제35조(보험료의 납입을 연체하여 해지된 계약의 부활(효력회복))에 따라 해지계약을 부활(효력회복)하
는 경우에는 부활(효력회복)일을 계약일로 하여 제1항 제1호에서 정한 보장개시일을 적용합니다.
③ 제3조(보험금의 지급사유) 제1호에서 장해지급률이 「암(갑상선암, 기타피부암 포함)」의 진단 확정일부
터 180일 이내에 확정되지 않는 경우에는 「암(갑상선암, 기타피부암 포함)」의 진단 확정일로부터 180
일이 되는 날의 의사진단에 기초하여 고정될 것으로 인정되는 상태를 장해지급률로 결정합니다. 다만,
「장해분류표」에 장해판정시기를 별도로 정한 경우에는 그에 따릅니다.
④ 제3항에 따라 장해지급률이 결정되었으나 그 이후 보장받을 수 있는 기간에 장해상태가 더 악화된 때에
는 그 악화된 장해상태를 기준으로 장해지급률을 결정하며, 계약의 효력이 없어진 경우에는 다음 각 호
의 기간 중에 악화된 장해상태를 기준으로 장해지급률을 결정합니다.
1. 보험기간이 10년 이상인 계약은 질병의 진단확정일부터 2년 이내
2. 보험기간이 10년 미만인 계약은 질병의 진단확정일부터 1년 이내
⑤「장해분류표」에 해당되지 않는 후유장해는 피보험자의 직업, 나이, 신분 또는 성별 등에 관계없이 신
체의 장해정도에 따라 「장해분류표」의 구분에 준하여 지급액을 결정합니다. 다만, 「장해분류표」의
‧ C16(위의 악성 신생물)이 뇌로 전이되어 C79.3(뇌 및 뇌막의 이차성 악성 신생물)로 진단된 경우에도
C16(위의 악성 신생물)에 해당하는 질병으로 봅니다.

- 44 -
각 장해분류별 최저 지급률 장해정도에 이르지 않는 후유장해에 대하여는 후유장해보험금을 지급하지
않습니다.
⑥ 보험수익자와 회사가 제3조(보험금의 지급사유)의 보험금의 지급사유에 대해 합의하지 못할 때는 보험
수익자와 회사가 함께 제3자를 정하고 그 제3자의 의견에 따를 수 있습니다. 제3자는 의료법 제3조(의
료기관)에 규정한 종합병원 소속 전문의 중에 정하며, 보험금 지급사유 판정에 드는 의료비용은 회사가
전액 부담합니다.
의료법 제3조(의료기관)
이 법에서 의료기관이라 함은 의료인이 공중 또는 특정 다수인을 위하여 의료・조산의 업을 행하는 곳
을 말합니다. 의료기관은 종합병원・병원・치과병원・한방병원・요양병원・정신병원・의원・치과의원・
한의원 및 조산원으로 나누어 집니다.
⑦ 같은 「암(갑상선암, 기타피부암 포함)」으로 두 가지 이상의 후유장해가 생긴 경우에는 후유장해 지급
률을 합산하여 지급합니다. 다만, 「장해분류표」의 각 신체부위별 판정기준에 별도로 정한 경우에는
그 기준에 따릅니다.
⑧ 다른 「암(갑상선암, 기타피부암 포함)」으로 인하여 후유장해가 2회 이상 발생하였을 경우에는 그 때
마다 이에 해당하는 후유장해 지급률을 결정합니다. 그러나 그 후유장해가 이미 후유장해보험금을 지급
받은 동일한 부위에 가중된 때에는 최종 장해상태에 해당하는 후유장해보험금에서 이미 지급받은 후유
장해보험금을 차감하여 지급합니다. 다만, 「장해분류표」의 각 신체부위별 판정기준에서 별도로 정한
경우에는 그 기준에 따릅니다.
⑨ 이미 이 보장에서 후유장해보험금 지급사유에 해당되지 않았거나(보장개시 이전의 원인에 의하거나 또
는 그 이전에 발생한 후유장해를 포함합니다), 후유장해보험금이 지급되지 않았던 피보험자에게 그 신
체의 동일 부위에 또다시 제7항에 규정하는 후유장해상태가 발생하였을 경우에는 직전까지의 후유장해
에 대한 후유장해보험금이 지급된 것으로 보고 최종 후유장해 상태에 해당되는 후유장해보험금에서 이
를 차감하여 지급합니다.
제6조(보험금을 지급하지 않는 사유)
회사는 다음 중 어느 한 가지로 보험금 지급사유가 발생한 때에는 보험금을 지급하지 않습니다. 또한 제31
조(보험료 납입면제)에서 정한 보험료 납입면제도 적용하지 않습니다.
1. 피보험자가 고의로 자신을 해친 경우. 다만, 피보험자가 심신상실 등으로 자유로운 의사결정을 할 수
없는 상태에서 자신을 해친 경우에는 보험금을 지급합니다.
2. 보험수익자가 고의로 피보험자를 해친 경우. 다만, 그 보험수익자가 보험금의 일부 보험수익자인 경
우에는 다른 보험수익자에 대한 보험금은 지급합니다.
3. 계약자가 고의로 피보험자를 해친 경우
4. 피보험자의 임신, 출산(제왕절개를 포함합니다), 산후기. 다만, 회사가 보장하는 보험금 지급사유와
보장개시일부터 2년이 지난 후에 발생한 습관성 유산, 불임 및 인공수정관련 합병증으로 인한 경우
에는 보험금을 지급합니다.
5. 전쟁, 외국의 무력행사, 혁명, 내란, 사변, 폭동
습관성 유산, 불임 및 인공수정관련 합병증
한국표준질병･사인분류상의 N96~N98에 해당하는 질병을 말합니다.
제7조(보험금 지급사유의 통지)
계약자 또는 피보험자나 보험수익자는 제3조(보험금의 지급사유)에서 정한 보험금 지급사유의 발생을 안
때에는 지체 없이 그 사실을 회사에 알려야 합니다.
제8조(보험금 등의 청구)
① 보험수익자는 다음의 서류를 제출하고 보험금을 청구하여야 합니다.

- 45 -
1. 청구서(회사 양식)
2. 사고증명서(진료비계산서, 사망진단서, 장해진단서, 입원치료확인서, 의사처방전(처방조제비) 등)
3. 신분증(주민등록증이나 운전면허증 등 사진이 붙은 정부기관발행 신분증, 본인이 아닌 경우에는 본인
의 인감증명서, 본인서명사실확인서 또는 안전성과 신뢰성이 확보된 전자적 수단을 활용한 보험수익
자 의사표시의 확인방법 포함)
4. 기타 보험수익자가 보험금 등의 수령 또는 보험계약자가 보험료 납입면제 청구에 필요하여 제출하는
서류
② 제1항 제2호의 사고증명서는 의료법 제3조(의료기관)에서 규정한 국내의 병원이나 의원 또는 국외의 의
료관련법에서 정한 의료기관에서 발급한 것이어야 합니다.
제9조(보험금 등의 지급절차)
① 회사는 제8조(보험금 등의 청구)에서 정한 서류를 접수한 때에는 접수증을 드리고 휴대전화 문자메시지
또는 전자우편 등으로도 송부하며, 그 서류를 접수한 날부터 3영업일 이내에 보험금을 지급합니다. 다
만, 화재손해 및 배상책임에 대한 서류를 접수한 때에는 그 서류를 접수 받은 후 지체없이 지급할 보험
금을 결정하고, 지급할 보험금이 결정되면 7일 이내에 보험금을 지급합니다.
② 회사가 보험금 지급사유를 조사ㆍ확인하기 위해 필요한 기간이 제1항의 지급기일을 초과할 것이 명백히
예상되는 경우에는 그 구체적인 사유와 지급예정일 및 보험금 가지급제도(회사가 추정하는 보험금의
50% 이내를 지급)에 대하여 피보험자 또는 보험수익자에게 즉시 통지합니다. 다만, 지급예정일은 다음
각 호의 어느 하나에 해당하는 경우를 제외하고는 제8조(보험금 등의 청구)에서 정한 서류를 접수한 날
부터 30영업일 이내에서 정합니다.
1. 소송제기
2. 분쟁조정 신청(다만, 대상기관은 금융분쟁조정위원회 또는 소비자 분쟁조정위원회)
3. 수사기관의 조사
4. 해외에서 발생한 보험사고에 대한 조사
5. 제6항에 따른 회사의 조사요청에 대한 동의 거부 등 계약자, 피보험자 또는 보험수익자의 책임 있는
사유로 보험금 지급사유의 조사와 확인이 지연되는 경우
6. 보험금 지급사유에 대해 제3자의 의견에 따르기로 한 경우
보험금 가지급제도
지급기한 내에 보험금이 지급되지 못할 것으로 판단될 경우 예상되는 보험금의 일부를 먼저 지급하는 제도.
이는 피보험자가 당장 필요로 하는 비용을 보전해주기 위해 회사가 먼저 지급해주는 임시 급부금입니다.
③ 제2항에 의하여 장해지급률의 판정 및 지급할 보험금의 결정과 관련하여 확정된 장해지급률에 따른 보
험금을 초과한 부분에 대한 분쟁으로 보험금 지급이 늦어지는 경우에는 보험수익자의 청구에 따라 이미
확정된 보험금을 먼저 가지급합니다.
④ 제2항에 의하여 추가적인 조사가 이루어지는 경우, 회사는 보험수익자의 청구에 따라 회사가 추정하는
보험금의 50% 상당액을 가지급보험금으로 지급합니다.
⑤ 회사는 제1항의 규정에 정한 지급기일 내에 보험금을 지급하지 않았을 때(제2항의 규정에서 정한 지급
예정일을 통지한 경우를 포함합니다)에는 그 다음날부터 지급일까지의 기간에 대하여 「보험금을 지급
할 때의 적립이율 계산」(【별표3】참조)에서 정한 이율로 계산한 금액을 보험금에 더하여 지급합니다.
그러나 계약자, 피보험자 또는 보험수익자의 책임 있는 사유로 지급이 지연된 때에는 그 해당기간에 대
한 이자는 더하여 지급하지 않습니다.
⑥ 계약자, 피보험자 또는 보험수익자는 제18조(알릴 의무 위반의 효과) 및 제2항의 보험금 지급사유조사
와 관련하여 의료기관, 국민건강보험공단, 경찰서 등 관공서에 대한 회사의 서면에 의한 조사요청에 동
의하여야 합니다. 다만, 정당한 사유 없이 이에 동의하지 않을 경우 사실 확인이 끝날 때까지 회사는
보험금 지급지연에 따른 이자를 지급하지 않습니다.
⑦ 회사는 제6항의 서면조사에 대한 동의 요청시 조사목적, 사용처 등을 명시하고 설명합니다.

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정당한 사유
‘정당한 사유’란 사회통념상 그 의무나 책임 등을 이행할 수 없을만한 사정이 있거나, 그 의무나 책임
등의 이행을 기대하는 것이 무리라고 할 만한 사정이 있을 때를 말합니다.
제10조(중도인출)
① 회사는 보험계약일부터 2년 이상 경과된 유효한 계약에 대하여 계약자의 신청이 있는 경우 매보험년도
마다 4회를 한도로 중도인출금을 지급합니다. 다만, 3형(30년갱신형)(해약환급금 미지급형)의 경우 중도
인출을 적용하지 않습니다.
보험년도
보험계약일부터 매1년 단위의 연도(당해연도 보험계약 해당일부터 다음년도 보험계약 해당일 전일까지
의 기간)를 말합니다. 예를 들어, 보험계약일이 2026년 8월 15일인 경우 보험년도는 2026년 8월 15일
부터 2027년 8월 14일까지 1년입니다.
② 제1항의 중도인출금은 기본계약 해약환급금과 기본계약 적립부분 해약환급금 중 적은 금액의 80%의 범
위 내에서 신청할 수 있습니다. 다만, 이 계약에 의한 대출금이 있을 때에는 그 대출원금과 이자의 합
계액을 공제한 후의 잔액을 기준으로 합니다.
중도인출금의 한도 예시
중도인출 시점에 ‘보험료 및 해약환급금 산출방법서’에 의해 산출된 기본계약 해약환급금과 기본계약 적
립부분 해약환급금 중 적은 금액이 100만원인 경우
⇒ 총 중도인출 가능액 = 100만원 × 80% = 80만원
⇒ 이미 신청한 대출금이 있는 경우(원리금 합계를 30만원으로 가정)
중도인출 가능액 = 80만원(총 중도인출 가능액) - 30만원 = 50만원
③ 계약자가 제1항의 중도인출금 신청에 따라 중도인출금을 지급받은 경우 「보험료 및 해약환급금 산출방
법서」에 따라 기본계약 적립부분 계약자적립액에서 해당 중도인출금액을 차감합니다.
보험료 및 해약환급금 산출방법서
이 보험의 보험료, 계약자적립액, 해약환급금 등의 산출에 대하여 수식으로 기재해 놓은 서류를 말합니다.
④ 중도인출시 기본계약 적립부분 계약자적립액에서 인출금액 및 인출금액에 적립되었을 이자만큼 차감되
므로 만기환급금 또는 해약환급금이 감소합니다.
계약자적립액
장래의 보험금, 해약환급금 등을 지급하기 위하여 계약자가 납입한 보험료 중 일정액을 회사가 적립해
둔 금액을 말합니다.
제11조(공시이율의 적용 및 공시)
① 1형(20년갱신형)(해약환급금지급형), 2형(30년갱신형)(해약환급금지급형)의 상품의 적립부분 계약자적립
액 계산시 적용되는 이율은 매월 1일 회사가 정한 공시이율(보장)로 합니다.
공시이율
전통적인 보험상품에 적용되는 이율이 장기・고정금리이기 때문에 시중금리가 급격하게 변동할 경우 이에
대응하지 못하는 점을 고려하여 시중의 지표금리 등에 연동하여 일정기간 마다 변동되는 이율을 말합니다.
이 보험의 공시이율은 매월 회사의 인터넷홈페이지 (www.heungkukfire.co.kr)의 “공시실”내 “상품공시/적
용이율”에 공시합니다.
② 제1항의 공시이율(보장)은 이 보험의 사업방법서에서 정하는 바에 따라 운용자산이익률과 외부지표금리
를 가중평균하여 산출된 공시기준이율에서 향후 예상수익 등을 고려한 조정률을 가감하여 결정합니다.

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사업방법서
이 보험의 사업방법서는 회사의 인터넷홈페이지(www.heungkukfire.co.kr)의 “공시실” 내 “상품공시”에
서 공시합니다.
운용자산이익률
직전 1년간의 운용자산에 대한 투자영업수익과 투자영업비용 등을 고려하여 산출합니다.
외부지표금리
국고채 수익률, 회사채 수익률, 통화안정증권 수익률, 양도성예금증서 유통수익률을 고려하여 산출합니다.
③ 보험기간 중에 제1항의 공시이율(보장)이 변경되는 경우에는 변경된 시점이후부터 변경된 이율을 적용
하며, 최저보증이율은 0.3%로 합니다.
최저보증이율
공시이율(보장)이 하락하더라도 회사에서 보증하는 최저한도의 적용이율입니다. 예를들어, 최저보증이율
이 0.3%인 경우 공시이율(보장)이 0.25%로 낮아지더라도 계약자적립액은 공시이율(보장)(0.25%)이 아
닌 최저보증이율(0.3%)로 적립됩니다. 따라서 계약자는 공시이율(보장)이 아무리 낮아지더라도 최저보증
이율로 적립한 계약자적립액은 보장받을 수 있습니다.
④ 회사는 제1항에서 정한 공시이율(보장)을 매월 회사의 인터넷홈페이지 등을 통해 공시합니다.
제12조(만기환급금의 지급)
① 회사는 계약자가 보험료를 완납하고 보험기간이 끝난 때에 만기환급금을 보험수익자에게 지급합니다.
이때 만기환급금은 적립부분 순보험료(적립보험료에서 적립부분 사업비를 공제한 보험료를 말합니다.
이하 같습니다)에 대하여 보험료 납입일(회사에 입금된 날을 말합니다)부터 이 계약의 공시이율(보장)로
「보험료 및 해약환급금 산출방법서」에 따라 계산합니다. 다만, 3형(30년갱신형)(해약환급금 미지급형)
의 경우 만기환급금을 지급하지 않습니다.
② 제1항의 만기환급금은 보험료의 자동대출납입에 따라 납입된 보험료와 이자, 보험계약대출에 따른 보험
계약대출금과 이자, 기 인출된 중도인출금이 있는 경우에는 그 원리금 합계액을 빼고 지급합니다.
보험계약대출
계약자가 자신이 가입한 보험을 담보로 하여 받는 대출을 말합니다.
③ 제1항의 공시이율(보장)이 보험기간중에 변경되는 경우에는 변경된 시점 이후부터 제11조(공시이율의
적용 및 공시)에 따라 변경된 이율을 적용하며, 최저보증이율은 연복리 0.3%로 합니다.
④ 회사는 계약자 및 보험수익자의 청구에 의하여 제1항에 의한 만기환급금을 지급하는 경우 청구일부터 3
영업일 이내에 지급합니다.
⑤ 회사는 제1항에 의한 만기환급금의 지급시기가 되면 지급시기 7일 이전에 그 사유와 지급할 금액을 계
약자 또는 보험수익자에게 알려드리며, 만기환급금을 지급함에 있어 지급일까지의 기간에 대한 이자의
계산은 「보험금을 지급할 때의 적립이율 계산」(【별표3】참조)에 따릅니다.
제13조(보험금 받는 방법의 변경)
① 계약자(보험금 지급사유 발생 후에는 보험수익자)는 회사의 사업방법서에서 정한 바에 따라 보험금의
전부 또는 일부에 대하여 나누어 지급받거나 일시에 지급받는 방법으로 변경할 수 있습니다.
② 회사는 제1항에 따라 일시에 지급할 금액을 나누어 지급하는 경우에는 나중에 지급할 금액에 대하여 평
균공시이율을 연단위 복리로 계산한 금액을 더하며, 나누어 지급할 금액을 일시에 지급하는 경우에는
평균공시이율을 연단위 복리로 할인한 금액을 지급합니다.

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평균공시이율
전체 보험회사 공시이율의 평균으로, 이 계약 체결 시점의 이율을 말합니다. 이 평균공시이율은 금융감
독원 홈페이지(www.fss.or.kr)의 「업무자료/보험업무」 내 「보험상품자료」에서 확인할 수 있습니다.
예시) 연단위 복리로 할인한 금액 계산법
* 3년동안 매년 100원의 금액을 일시에 받고자 할 때(평균공시이율10%)
→ 100원(현재 받을금액)
+ 100원(내년 지급예정 금액) ÷ (1 + 10%)(1년차 할인)
+ 100원(내년 지급예정 금액) ÷ (1 + 10%)(1년차 할인) ÷ (1 + 10%)(2년차 할인)
제14조(주소변경통지)
① 계약자(보험수익자가 계약자와 다른 경우 보험수익자를 포함합니다)는 주소 또는 연락처가 변경된 경우
에는 지체 없이 그 변경내용을 회사에 알려야 합니다.
② 제1항에서 정한대로 계약자 또는 보험수익자가 변경내용을 알리지 않은 경우에는 계약자 또는 보험수익
자가 회사에 알린 최종의 주소 또는 연락처로 등기우편 등 우편물에 대한 기록이 남는 방법으로 회사가
알린 사항은 일반적으로 도달에 필요한 기간이 지난 때에 계약자 또는 보험수익자에게 도달된 것으로
봅니다.

제15조(보험수익자의 지정)
① 보험수익자를 지정하지 않은 때에는 보험수익자를 아래에서 정한 자로 합니다.
1. 만기환급금의 경우에는 보험계약자
2. 사망보험금의 경우에는 피보험자의 법정상속인
3. 사망보험금 이외의 보험금을 보장하는 경우에는 해당 계약의 피보험자
② 제1항에 따라 지정된 보험수익자가 보험기간 중에 사망한 때에는 계약자는 다시 보험수익자를 지정할
수 있으며, 이 경우에 계약자가 보험수익자를 지정하지 않고 사망한 때에는 보험수익자의 법정상속인을
보험수익자로 합니다.
법정상속인
피상속인의 사망으로 인해 민법에서 정한 상속의 순위에 따라 상속인이 되는 자를 말합니다.
제16조(대표자의 지정)
① 계약자 또는 보험수익자가 2명 이상인 경우에는 각 대표자를 1명 지정하여야 합니다. 이 경우 그 대표
자는 각각 다른 계약자 또는 보험수익자를 대리하는 것으로 합니다.
② 지정된 계약자 또는 보험수익자의 소재가 확실하지 않은 경우에는 이 계약에 관하여 회사가 계약자 또
는 보험수익자 1명에 대하여 한 행위는 각각 다른 계약자 또는 보험수익자에게도 효력이 미칩니다.
③ 계약자가 2명 이상인 경우에는 그 책임을 연대로 합니다.
계약자가 2명 이상인 경우
계약자가 2명 이상인 경우 계약전 알릴의무, 보험료 납입의무 등 보험계약에 따른 계약자의 의무를 연
대로 합니다.
연대책임
두사람 이상이 각각 동일한 내용의 책임을 지는 것을 말합니다.

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제3관 계약자의 계약 전 알릴 의무 등
제17조(계약 전 알릴 의무)
계약자 또는 피보험자는 청약할 때(진단계약의 경우에는 건강진단할 때를 말합니다) 청약서에서 질문한 사
항에 대하여 알고 있는 사실을 반드시 사실대로 알려야(이하 ‘계약 전 알릴 의무’라 하며, 상법상 ‘고지의
무’와 같습니다) 합니다. 다만, 진단계약의 경우 의료법 제3조(의료기관)의 규정에 따른 종합병원과 병원에
서 직장 또는 개인이 실시한 건강진단서 사본 등 건강상태를 판단할 수 있는 자료로 건강진단을 대신할 수
있습니다.
상법 제651조(고지의무위반으로 인한 계약해지)
보험계약당시에 보험계약자 또는 피보험자가 고의 또는 중대한 과실로 인하여 중요한 사항을 고지하지
아니하거나 부실의 고지를 한 때에는 보험자는 그 사실을 안 날로부터 1월내에, 계약을 체결한 날로부
터 3년내에 한하여 계약을 해지할 수 있다. 그러나 보험자가 계약당시에 그 사실을 알았거나 중대한 과
실로 인하여 알지 못한 때에는 그러하지 아니한다.
【 제651조의 2(서면에 의한 질문의 효력) 】
보험자가 서면으로 질문한 사항은 중요한 사항으로 추정한다.
<사례>
보험계약 청약을 하면서 보험설계사에게 고혈압이 있다고만 얘기하였을 뿐, 청약서의 계약전 알릴사항에
아무런 기재도 하지 않았을 경우에는 보험설계사에게만 고혈압 병력을 얘기하였다고 하더라고 회사는 계
약전 알릴의무 위반을 이유로 계약을 해지하고 보험금을 지급하지 않을 수 있습니다.
제18조(알릴 의무 위반의 효과)
① 회사는 계약자 또는 피보험자가 고의 또는 중대한 과실로 제17조(계약 전 알릴 의무)를 위반하고 그 의
무가 중요한 사항에 해당하는 경우에는 손해의 발생여부에 관계없이 이 계약을 해지할 수 있습니다.
② 제1항의 경우에도 불구하고 다음 중 하나에 해당하는 경우에는 회사는 계약을 해지할 수 없습니다.
1. 회사가 최초계약(갱신형 특별약관이 있는 경우 갱신형 보장의 최초계약) 체결 당시에 그 사실을 알
았거나 과실로 인하여 알지 못하였을 때
2. 회사가 그 사실을 안 날부터 1개월 이상 지났거나 또는 제1회 보험료를 받은 때부터 보험금 지급사
유가 발생하지 않고 2년(진단계약의 경우 질병에 대하여는 1년)이 지났을 때
3. 최초계약(갱신형 특별약관이 있는 경우 갱신형 보장의 최초계약)을 체결한 날부터 3년이 지났을 때
4. 회사가 이 계약을 청약할 때 피보험자의 건강상태를 판단할 수 있는 기초자료(건강진단서 사본 등)
에 따라 승낙한 경우에 건강진단서 사본 등에 명기되어 있는 사항으로 보험금 지급사유가 발생하였
을 때. 다만, 계약자 또는 피보험자가 회사에 제출한 기초자료의 내용 중 중요사항을 고의로 사실과
다르게 작성한 때에는 계약을 해지할 수 있습니다.
5. 보험설계사 등이 계약자 또는 피보험자에게 고지할 기회를 주지 않았거나 계약자 또는 피보험자가
사실대로 고지하는 것을 방해한 경우, 계약자 또는 피보험자에게 사실대로 고지하지 않게 하였거나
부실한 고지를 권유했을 때. 다만, 보험설계사 등의 행위가 없었다 하더라도 계약자 또는 피보험자
가 사실대로 고지하지 않거나 부실한 고지를 했다고 인정되는 경우에는 계약을 해지할 수 있습니다.
③ 제1항에 따라 계약을 해지하였을 때에는 제40조(해약환급금)에서 정한 해약환급금을 계약자에게 지급합
니다.
④ 제1항 제1호에 의한 계약의 해지가 보험금 지급사유 발생 후에 이루어진 경우에 회사는 보험금을 지급
하지 않으며, 계약 전 알릴 의무 위반사실(계약해지 등의 원인이 되는 위반사실을 구체적으로 명시)뿐만
아니라 계약 전 알릴 의무사항이 중요한 사항에 해당되는 사유를 “반대증거가 있는 경우 이의를 제기할
수 있습니다”라는 문구와 함께 계약자에게 서면 또는 전자문서 등으로 알려 드립니다. 회사가 전자문서
로 안내하고자 할 경우에는 계약자에게 서면 또는 「전자서명법」 제2조 제2호에 따른 전자서명으로

전체 약관 보기 (PDF, 761페이지)