First of all, the traditional risk control methods include:
① Risk control in the design stage of clauses.
② Risk control in underwriting process.
③ Risk control in claim settlement.
④ Reinsurance is the first way of risk transfer.
Second, the new risk control methods include:
① Control of medical service process.
② Medical service compensation mode.
③ Profit sharing measures such as preferential treatment without indemnity.
④ Health management mechanism.
⑤ Management medical care.
Third, what does health insurance mean?
Health insurance is a kind of personal insurance that takes people's health as the insurance object and compensates the insured for the expenses or losses caused by illness or accidental injury. Common health insurance includes critical illness insurance and medical insurance.
1, critical illness insurance
Critical illness insurance refers to the commercial insurance behavior handled by insurance companies, taking certain major diseases, such as malignant tumors and leukemia, as the insurance objects. When the insured suffers from the above diseases, the insurance company will give appropriate compensation for medical expenses. According to the guarantee period, it can be divided into regular critical illness insurance and lifelong critical illness insurance, which is suitable for people with different budgets.
2. Medical insurance
Medical insurance refers to the insurance that provides protection for the medical expenses of the insured during medical treatment when the medical behavior agreed in the insurance contract occurs. Simply put, it is the insurance that the insured can pay when he goes to the clinic or hospital. It is an insurance product that reimburses the expenses incurred by the insured in hospital treatment. Small hospitalization insurance, millions of medical insurance, high-end medical insurance and hospitalization allowance insurance all belong to this category.
Fourth, the role of health insurance.
1, the role of medical insurance
The reimbursement payment method used in medical insurance is based on the reasonable and necessary medical expenses caused by illness or accident, which need to be paid according to the invoice, and the insurance premium paid will not exceed the actual medical expenses. Micro-medical insurance is an effective tool to solve the medical expenses of minor diseases, which can be used for the medical expenses of common diseases that can not meet the reimbursement standard of millions of medical insurance. For some minor illnesses, it can effectively supplement social security, solve the problem of one million medical insurance deductibles, and reduce the out-of-pocket part of medical expenses to some extent.
2, the role of critical illness insurance
Critical illness insurance adopts the method of immediate payment after diagnosis, and the insurance company pays the insurance premium agreed in the contract in one lump sum, and the insurance premium paid is not limited to use. At present, the protection of critical illness insurance is relatively comprehensive. In addition to serious diseases, it also includes mild and moderate diseases. You can use this money to treat diseases, subsidize your family or pay off your family debts. Moreover, suffering from a serious illness requires a long recovery period, and the insurance money paid can also be used as rehabilitation expenses.
Medical insurance is only responsible for the cost of treatment, and the loss of lost time due to illness is not guaranteed. The insurance money paid by critical illness insurance can not only be used for treatment, but also make up for various economic losses caused by major diseases. The best suggestion is that the critical illness insurance and medical insurance should be combined into one, and the major and minor diseases should be taken into account and supplemented with each other to better play the role of insurance.