Health management services provided by insurance companies refer to the behaviors of monitoring, analyzing and evaluating customers' health status, intervening in health risk factors, controlling the occurrence and development of diseases, and maintaining a healthy state, including health examination, health consultation, health promotion, disease prevention, chronic disease management, medical services and rehabilitation nursing.
Insurance companies provide health management services by preventing disease occurrence, controlling disease development, promoting disease rehabilitation, reducing disease incidence, improving health level; Enrich the connotation of health insurance business and strengthen the professional ability of risk management; Promote the rational utilization of health service resources and optimize the allocation and integration of health service resources.
If the health management services provided by an insurance company are included in the insurance product liability clauses, the cost sharing shall not exceed 20% of the net insurance premium, and the main contents of the health management services shall be specified in the clauses, and the pricing basis shall be explained in the actuarial report. If an insurance company provides health management services alone, it shall sign a health management service contract, and indicate the service content and service price in the contract.
Health management services of insurance companies include:
Physical examination, health consultation, health promotion, disease prevention, chronic disease management, medical service and rehabilitation nursing. For the related services that insurance companies cannot carry out, this notice also gives a clear direction: to carry out services within the scope of medical institutions' practice licenses; The security is inaccurate or there are obvious security problems.
Involving moral hazard or moral problems; Techniques and methods that have not been medically confirmed or proved to be ineffective; Detection methods that cannot be objectively evaluated or whose results are unreliable; Services that are obviously unrelated to the health needs of customers; Other services unsuitable for development.
The Notice requires insurance companies to follow six principles in developing health management services, namely, scientificity, rationality, safety, effectiveness, objectivity and compliance with ethical requirements. At the same time, insurance companies should respect customers' informed consent rights, protect customers' privacy rights, ensure the safety of relevant data and information, and make timely service evaluation feedback and complaint handling.
The above content comes from the Media Protection Alliance.