A Study on the Issues of Underwriting and Claim for Health Insurance in the Non-Life Insurance Industry

• Main Authors: Kuo-Chin Lin, 林國欽
• Other Authors: Li-Chu Lin
• Format: Others
• Language: zh-TW
• Published: 2007
• Online Access: http://ndltd.ncl.edu.tw/handle/57541260381412720362

碩士 === 淡江大學 === 保險學系保險經營碩士在職專班 === 95 === This study aimed to analyze the trials and challenges the property insurance industry might need to cope with when providing health insurance services. Among others, issues about the two core activities of health insurance, underwriting and compensation, were proposed and discussed in an attempt to attain the following results: 1.An overview of the health insurance could help understand the fundamental concept of the health insurance, insurance types, coverage of each insurance type, and the rules and prescriptions pertaining to the health insurance. 2.The problems that health insurance providers might need to cope with were examined by probing into the current environment of the health insurance market and domestic life insurance industry’s experiences about managing the health insurance. 3.Challenges in the underwriting process that the property insurance industry might have to deal with included: an underwriting effect as good as that on the life insurance industry could not be attained, the underwriting challenge from multiple channels, unfamiliarity with prescriptions, and the difficulty in establishing a physical check-up system. 4.Challenges in compensation that the property insurance industry might need to deal with included: a poor access to medical records, the difficulty in detecting compensation fraud, lack of experiences in filing compliant for disputes in health insurance compensation, and the difficulty in analyzing medical records. 5.Finally, it was expected that suggestions or coping strategies could be worked out from the above-mentioned discussions and serve as a reference for property insurance providers to manage health insurance services in the future.