Health insurance, referred to as health insurance, mainly includes medical insurance, sickness insurance, disability income loss insurance, nursing insurance and medical accident insurance. Refers to the life insurance in which the insurer pays insurance money to the insured when he is ill. The payment scope of health insurance usually includes medical expenses, income loss, funeral expenses and living expenses of survivors. This kind of insurance is mostly co-organized with injury insurance and life insurance.
In order to prevent moral hazard, the insurer usually stipulates a trial insurance period when handling health insurance. After this period, the insurer will be liable for the losses caused by the insured's illness.
According to the payment method, health insurance can be divided into three types:
1, payment type, when the insured suffers from diseases or circumstances agreed in the insurance contract, the insurance company pays the insurance money to the insured according to the contract. The amount of insurance money is fixed. Once diagnosed, the insurance company will pay the insurance money in one lump sum according to the insurance amount specified in the contract. The critical illness insurance of all insurance companies belongs to the payment type.
2. Reimbursement type: the insurance company reimburses the medical expenses actually paid by the insured according to the proportion agreed in the insurance contract. Such as hospitalization medical insurance and accidental injury medical insurance. It belongs to the reimbursement type.
3. Subsidized, the insurance company pays the insurance premium according to the actual hospitalization days and surgical items of the insured. The insurance premium is generally calculated on a daily basis, and the total amount of insurance premium varies according to the number of days of hospitalization and the different surgical items. Such as hospitalization medical subsidy insurance and hospitalization peace of mind insurance. There are subsidies.
The main factors that determine the rate of health insurance are: morbidity, disability rate, course of disease, interest rate, expense rate, failure rate and mortality rate. Other factors, such as exhibition mode, underwriting habits, claims principle, and the company's main objectives, will also affect the health insurance rate. The changes in hospital management and medical methods, economic development, geographical environment and other conditions also have an impact on our future salary forecast, but these factors are not easy to be predicted completely and accurately.
1. Uniform rate principle
2. Step rate principle
3. The principle of changing the rate year by year
4. The principle of insurance premium balance
Although the above methods have their own advantages, passive safety factors such as risk assessment, cost payment and profit must be considered at the same time.
For the insured who can't meet the health requirements stipulated in the standard terms but can be conditionally underwritten, they can be underwritten according to the sub-standard policy. The commonly used methods in setting the rate are:
(1) Reduce the payment period of policy income.
(2) Reduce policy income
(3) Increase the waiting time
(4) Provisions on exclusions or restrictions on guarantees, etc.