Health insurance, risk factors linked to the core of the insurance policy

Health insurance, a late start, and mostly by life insurance companies to operate. So, has always been subordinate to the management of health insurance, life insurance management, the traditional management methods and mode of life. Reflected in the underwriting, health insurance, the lack of targeted underwriting the risk assessment approaches and strategies, usually based on the characteristics of life insurance products to consider and assess the risk factors to determine the underwriting conditions and methods. Over time, not only does not reflect the underwriting work, "different levels of risk at different rates," the purpose of health insurance, but also will bring big business potential risks, a direct result of higher payment rates. Since September 1, 2006 started the implementation of the "Health Insurance Regulations", provides insurance companies continue to have health insurance should be one of the conditions is to establish health insurance underwriting system and the claims system clarifies the health insurance of nuclear Paul should be based on characteristics of the establishment of their own health insurance, professional underwriting system, application techniques and professional approach to underwriting.

1, commercial health insurance underwriting risk factors

(1) health insurance underwriting major consideration risk factors.

1. The insured person's age: for medical expenses insurance, and short-term disability income insurance, before the age of 55 increased risk is not obvious; long-term care insurance and long-term increase in income insurance risk and mortality increase as fast.

2. Sex: Sex on health insurance coverage have a major impact. In addition to other accidents are usually older ages, women's disability rate is higher than men; and gender and the incidence of certain diseases are closely related.

3. Health status: The main assessment of the insured's existing injuries, illnesses and past history of payment for the future potential impact. Underwriting division or accidental harm to the past history of the degree of emphasis varies according to specific circumstances.

4. The financial situation: mainly through the understanding of the financial situation to determine whether the insured person's income to support the application for coverage, the insurance will usually be a certain percentage of annual income to set a payment limit. Audit the financial situation is to prevent adverse selection or moral hazard, insured an important tool.

5. Occupation: occupational risk will primarily affect the probability of disability of the insured person, for the insured person engaged in the classification of certain jobs are usually carried out to determine the different risk levels.

6. Other factors: If an insured person smoking or alcohol habits and risk factors such as hobbies and sports, to the health of the insured person may bring some negative effects, but also need to assess the elements. In addition, whether the insured person to participate in social health insurance is also directly affect the underwriting expense reimbursement products an important consideration factor.

Through the above the health insurance underwriting risk factors considered in the analysis of health insurance underwriting of the main features can be summarized as follows:

(1) the responsibility for health insurance are quite different for different health insurance underwriting points of consideration are different.

(2), compared with the life insurance, health insurance, life insurance underwriting will be more than difficult. Health insurance underwriting main consideration was the rate of disability, morbidity rather than mortality, and health insurance must be considered morbidity, disability rates are closely related to risk factors. Furthermore, health insurance, less accumulation of empirical data, but also to the more difficult job of underwriting.

(3) The adverse selection problem. Health insurance, non-death-type insurance as a condition of payment of insurance against the occurrence of the insured person a threat to life than the high life, coupled with the beneficiaries of the insured person himself, the responsibility of the accident insurance easier to define the scope of differences occurred against the the opportunity to choose much more than the life insurance.

(B) social basic medical insurance, supplementary medical insurance underwriting risk factors

With the deepening of structural reforms to promote national health and health insurance services are continually expanding, involved in the participation in supplementary medical insurance for urban workers, a new type rural cooperative medical supplementary medical insurance, supplementary medical insurance for urban residents. With other than purely commercial health insurance, such business has obvious policy relevance, risk control more difficult, less so on their own the right to choose, and the market price competition is more intense in the grasp of such key issues as pricing depends on the social security department. Reflected in the underwriting work, simply consider each and every one of the insured person's health status become meaningless in this, its risk factors are: