Knowledge explosion training camp
In order to further standardize and support the business of urban customized commercial medical insurance (Huimin insurance products).State Administration of Financial Supervision and Administration, National Medical Security AdministrationJointly draftedNotice on Carrying Out Urban Customized Commercial Medical Insurance in a Smooth and Orderly Manner(Draft for Comments) and solicit opinions from a wide range of people – mainly local ** and insurance companies.
1. The Draft clarifies the three major functions of Huimin Insurance:
* Guidance, market operation;Meet the actual medical security needs of the local people;Scientifically determine insurance liability and insurance rates (pricing) based on local Medicare medical data.
1. Huimin Insurance should adhere to the best guidance and market operation.
*It can only guide the design and operation of products, and cannot provide mandatory convenience for product promotion, and residents are free to insure insurance.
2. Huimin Insurance shall meet the actual medical security needs of the local people.
Mainly for the design of some products, it looks good, but in fact, the local operation is a chicken feather, and the insured can not get benefits, so the responsibility of the future product should be appropriate, and the reimbursement requirements should be appropriate.
3. Huimin Insurance shall scientifically determine the insurance liability based on relevant data such as local basic medical insurance and serious illness insuranceRen and rate levels.
Insurance liability and product pricing should have local characteristics, and should not be the same in various cities, especially the products designed by some national companies and related health operation companies.
2. Product design and operation
1. Huimin Insurance products should be personal insuranceproducts,Long-term medical insurance designed as a rate adjustable is encouraged.
2. Huimin Insurance products can be appropriately classified or ratedThe rate is determined based on the average risk level of the insured within the group, which should not be priced separately for patients with pre-existing conditionsDeductibles and payouts can be adjusted moderately.
3. The insurance company should conduct a retrospective analysis every year. The rate will be adjusted based on the deviation between the actual payout in the policy year and the estimated payout of the benefit plan.
In fact, the above three points have left an opening for many pension insurance companies to operate such products, such as a certain security (long-term medical products). It is also to prevent some insurance companies from thinking that the product is not profitable and stop operating the product in the second year, resulting in the long-term sustainability of local resident insurance coverage (personnel and rate grouping, annual rate adjustment, etc.).
3. The Draft emphasizes that the following 11 issues will be investigated and dealt with:
1. Failure to strictly abide by the rules of commercial insurance operation and give other benefits other than those agreed in the contract;
2. Adjust the insurance liability during the insurance period, fail to strictly calculate the claim according to the insurance liability, and pay the expenses other than the insurance liability;
3. Failure to adjust and reduce deviations in a timely manner according to the results of business backtracking;
4. Carry out business in the form of group orders;
5. The design of insurance liability is unreasonable, and the rate determination lacks the necessary data basis
6. Failure to submit the guarantee plan as required
7. Exaggerating publicity, making improper promises, misleading policyholders, and falsely using the name of ** to carry out false publicity;
8. Malicious price competition, illegal payment of handling fees, brokerage fees or other fees;
9. Delay and regret compensation, unreasonable refusal to compensate;
10. Leaking or using the personal information of the insured people in violation of laws and regulations;
11. The third-party organization that cooperates has violated laws and regulations.