TW202129586A - Mutual insurance system and mutual insurance method including a database, a settlement claiming subsystem, an insurance premium subsystem and an underwriting subsystem - Google Patents
Mutual insurance system and mutual insurance method including a database, a settlement claiming subsystem, an insurance premium subsystem and an underwriting subsystem Download PDFInfo
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本發明是有關於一種保險系統及方法,特別是指一種管理互助保險的互助保險系統及互助保險方法。The invention relates to an insurance system and method, in particular to a mutual insurance system and a mutual insurance method for managing mutual insurance.
傳統商業保險之系統通常都配合商品架構,採每年、每季、或每月定期繳費的收費方式,並透過精算定價來釐定各繳別費率。再者,保戶的繳費義務與商品實際理賠狀況無關,往往在無人出險的情況下,保戶仍須定期繳交固定的金額。因此,是否存有其他的保險系統,以解決習知的保險模式便成為一個待解決的問題。Traditional commercial insurance systems usually cooperate with the commodity structure, adopting annual, quarterly, or monthly payment methods, and use actuarial pricing to determine individual payment rates. Furthermore, the payment obligation of the policyholder has nothing to do with the actual claim settlement status of the product. Often when no one is in danger, the policyholder still has to pay a fixed amount on a regular basis. Therefore, whether there are other insurance systems to solve the conventional insurance model has become a problem to be solved.
因此,本發明的目的,即在提供一種管理互助保險的互助保險系統及互助保險方法。Therefore, the purpose of the present invention is to provide a mutual insurance system and a mutual insurance method for managing mutual insurance.
於是,根據本發明之一觀點,提供一種互助保險系統,適用於多個電腦裝置,並包含一資料庫、一理賠子系統、一保費子系統、及一核保子系統。Therefore, according to one aspect of the present invention, a mutual insurance system is provided, which is suitable for multiple computer devices and includes a database, a claims settlement subsystem, a premium subsystem, and an underwriting subsystem.
該資料庫儲存一對應一團險的團險名冊,該團險名冊包含分別對應多個被保險人的多個要保資料。該理賠子系統電連接該資料庫,並根據該等電腦裝置之其中至少一者所對應的至少一理賠資料,執行理賠審核,以產生通過理賠審核的一當日總理賠金額及一給付理賠指令,每一該理賠資料對應該團險名冊的該等被保險人之其中一者。The database stores a group insurance roster corresponding to a group insurance, and the group insurance roster contains multiple insured data corresponding to multiple insured persons. The claims sub-system is electrically connected to the database, and performs a claim review based on at least one claim data corresponding to at least one of the computer devices to generate a prime claim amount and a payment instruction for the day that passed the claim review. Each such claim data corresponds to one of the insured persons in the group insurance roster.
該保費子系統電連接該理賠子系統及該資料庫,並每日計算該當日總理賠金額除以該團險名冊中所對應的有效被保險人總數,而獲得當日的一分攤費用,且產生分別對應該團險名冊中的該等被保險人的多個繳交保費指令。每一該繳交保費指令所對應的金額是該分攤費用,對應每一該被保險人的該分攤費用的上限為該被保險人的一預定年繳保費減去該被保險人的一已繳加入費用,再減去該被保險人的一已繳分攤費用。The premium subsystem is electrically connected to the claims subsystem and the database, and calculates the prime claim amount of the day divided by the total number of valid insureds corresponding to the group insurance roster to obtain a share of the cost of the day, and generate Respectively correspond to the multiple premium payment instructions of the insured persons in the group insurance roster. The amount corresponding to each premium payment instruction is the apportionment cost, and the upper limit of the apportionment cost corresponding to each insured person is a predetermined annual premium paid by the insured person minus a paid premium of the insured person Add in expenses, minus a paid share of the insured person's expenses.
該核保子系統電連接該資料庫及該理賠子系統,並根據通過理賠審核的該至少一理賠資料及該團險名冊,於理賠審核日的翌日零時起刪除該團險名冊中已通過理賠審核的該至少一被保險人所對應的該至少一要保資料,以產生並儲存於該資料庫的更新的該團險名冊。The underwriting subsystem is electrically connected to the database and the claims sub-system, and based on the at least one claim information and the group insurance roster that have passed the claims review, delete the group insurance roster from the group insurance roster that has passed the claims at 0:00 on the day after the claim review date The at least one insured data corresponding to the reviewed at least one insured is generated and stored in the updated group insurance roster of the database.
在一些實施態樣中,其中,初始時,該核保子系統根據分別來自該等電腦裝置且分別對應該等被保險人的該等要保資料,並對該等要保資料執行檢核,以產生包括檢核成功的該等要保資料的一檢核名冊,且根據該檢核名冊及一已繳加入費用名冊,產生初始的該團險名冊,並將該團險名冊儲存於該資料庫。該保費子系統電連接該核保子系統,以接收該檢核名冊,並對該檢核名冊的每一該要保資料所對應的一繳款方式執行對應扣繳一加入費用,以產生包括扣繳成功的該等要保資料的該已繳加入費用名冊,該加入費用的金額等於該已繳加入費用。In some implementations, in the initial stage, the underwriting subsystem performs a check on the required information from the computer devices and corresponding to the insured persons, so as to Generate a check list that includes the information to be insured that have been successfully checked, and generate an initial group insurance list based on the check list and a paid-in fee list, and store the group insurance list in the database . The premium subsystem is electrically connected to the underwriting subsystem to receive the check list, and perform corresponding withholding and one-addition fees for each payment method corresponding to each of the insured data in the check list, so as to generate the deduction The amount of the paid-in fee list of the required insurance materials that has been successfully paid is equal to the paid-in fee.
在一些實施態樣中,其中,該團險名冊所對應的保險期間是從一起始日開始的一年,該保費子系統對在該起始日加入該檢核名冊的每一該被保險人所對應的該繳款方式執行對應扣繳該加入費用。在該年之內,該核保子系統根據來自該任何一個該電腦裝置且對應該被保險人的該要保資料,並對該要保資料執行檢核,以產生包括檢核成功的該要保資料的該檢核名冊。該保費子系統對該檢核名冊的該要保資料所對應的該繳款方式執行對應扣繳該加入費用,以產生包括扣繳成功的該要保資料的該已繳加入費用名冊。該核保子系統再根據該檢核名冊及該已繳加入費用名冊,產生更新的該團險名冊,並儲存於該資料庫。In some implementation aspects, the insurance period corresponding to the group insurance roster is one year from a starting date, and the premium subsystem provides for each insured who joins the inspection roster on the starting date. The execution of the corresponding payment method corresponds to the deduction of the joining fee. Within the year, the underwriting subsystem performs a check on the required information from any of the computer devices and corresponding to the insured to generate the required insurance including the successful verification. The check list of data. The premium subsystem executes the corresponding withholding of the joining fee for the payment method corresponding to the required insurance data in the check list, so as to generate the paid joining fee list including the required insurance information successfully withheld. The underwriting subsystem then generates an updated group insurance roster based on the check roster and the paid-in fee roster, and stores it in the database.
在一些實施態樣中,其中,該保費子系統在該年的最後一日,根據當日的該團險名冊及該年之內的所有該分攤費用,計算該團險名冊中每一該被保險人所要繳納的一年繳保費差額,並產生對應的一最後繳費指令,且於收到該團險名冊中每一該被保險人的該年繳保費差額後給付該團險的一經驗退費,每一該被保險人的該年繳保費差額等於該預定年繳保費減去該加入費用,再減去該被保險人在該年之內所有該分攤費用之總和,該團險的該經驗退費等於K*(應繳保費之收入-營業費用-理賠支出)-前N年度之累積虧損,K大於等於0且小於等於100%,N等於0或正整數。In some implementations, the premium subsystem calculates every insured in the group insurance roster on the last day of the year based on the group insurance roster on that day and all the shared expenses in the year The difference in premiums paid in one year to be paid by the person, and a corresponding final payment instruction is generated, and an experience refund of the group insurance is paid after receiving the difference in premiums paid by each insured in the group insurance list for that year , The difference in premiums paid by each insured person in that year is equal to the scheduled annual premium paid minus the joining fee, minus the sum of all the apportioned expenses of the insured person in the year, the experience of the group insurance The refund is equal to K* (income from premiums payable-operating expenses-claim settlement expenses)-cumulative losses for the previous N years, K is greater than or equal to 0 and less than or equal to 100%, and N is equal to 0 or a positive integer.
在一些實施態樣中,其中,當該保費子系統接收到來自該電腦裝置之其中一者在一退出日的一退出申請時,計算對應該電腦裝置的該被保險人的一應繳保費與一實繳保費的一差值,並在判斷該差值小於零時,產生金額對應該差值的一退款指令,而在判斷該差值大於等於零時,且再決定在該退出日之前的一欠繳保費總額與該差值之其中最小者等於一補收金額,以產生金額對應該補收金額的一補收指令。該實繳保費等於對應的該被保險人的該加入費用及該已繳分攤費用之總和。該核保子系統根據該退出申請,於該退出日的翌日零時起刪除該團險名冊中對應該被保險人的該要保資料,以產生並儲存於該資料庫的更新的該團險名冊。In some embodiments, when the premium subsystem receives a withdrawal application from one of the computer devices on a withdrawal day, it calculates the premium payable by the insured person corresponding to the computer device and A difference in the actual premium paid, and when it is judged that the difference is less than zero, a refund instruction corresponding to the difference is generated, and when it is judged that the difference is greater than or equal to zero, the amount before the withdrawal date is determined The smallest of the total outstanding premiums and the difference is equal to a supplementary payment amount to generate a supplementary payment instruction of the amount corresponding to the supplementary payment amount. The actually paid premium is equal to the sum of the corresponding insured's joining fee and the paid apportionment fee. According to the withdrawal application, the underwriting subsystem deletes the insured data corresponding to the insured in the group insurance register from 0:00 on the day following the withdrawal date to generate and store the updated group insurance register in the database. .
於是,根據本發明之另一觀點,提供一種互助保險方法,適用於多個電腦裝置及一互助保險系統,並包含步驟(a)~(d)。Therefore, according to another aspect of the present invention, a mutual insurance method is provided, which is applicable to multiple computer devices and a mutual insurance system, and includes steps (a) to (d).
於步驟(a),藉由該互助保險系統儲存一對應一團險的團險名冊,該團險名冊包含分別對應多個被保險人的多個要保資料。In step (a), the mutual insurance system stores a group insurance roster corresponding to a group insurance, and the group insurance roster includes multiple insurance data corresponding to multiple insured persons.
於步驟(b),藉由該互助保險系統根據該等電腦裝置之其中至少一者所對應的至少一理賠資料,執行理賠審核,以產生通過理賠審核的一當日總理賠金額及一給付理賠指令,每一該理賠資料對應該團險名冊的該等被保險人之其中一者。In step (b), the mutual insurance system executes a claim review based on at least one claim data corresponding to at least one of the computer devices, so as to generate a prime claim amount of the day that passes the claim review and a payment instruction , Each of the claims data corresponds to one of the insured persons in the group insurance roster.
於步驟(c),藉由該互助保險系統每日計算該當日總理賠金額除以該團險名冊中所對應的有效被保險人總數,而獲得當日的一分攤費用,且產生分別對應該團險名冊中的該等被保險人的多個繳交保費指令,每一該繳交保費指令所對應的金額是該分攤費用,對應每一該被保險人的該分攤費用的上限為該被保險人的一預定年繳保費減去該被保險人的一已繳加入費用,再減去該被保險人的一已繳分攤費用。In step (c), the mutual insurance system calculates the amount of prime compensation for that day divided by the total number of valid insured persons corresponding to the group insurance roster on a daily basis to obtain a share of the cost of the day, and generate a corresponding group There are multiple premium payment instructions of the insured persons in the insurance register, the amount corresponding to each premium payment instruction is the apportionment cost, and the upper limit of the apportionment cost corresponding to each insured is the insured A person’s scheduled annual premium minus the insured’s paid joining fee, and then the insured’s paid apportionment fee.
於步驟(d),藉由該互助保險系統根據通過理賠審核的該至少一理賠資料及該團險名冊,於理賠審核日的翌日零時起刪除該團險名冊中已通過理賠審核的該至少一被保險人所對應的該至少一要保資料,以產生並儲存更新的該團險名冊。In step (d), based on the at least one claim data and the group insurance list that have passed the claim review, the mutual insurance system deletes the at least one group insurance list that has passed the claims review from 0:00 on the day after the claim review date. The at least one insured data corresponding to an insured person is used to generate and store the updated group insurance roster.
在一些實施態樣中,該互助保險方法還包含在步驟(a)之前的步驟(e),初始時,該互助保險系統根據分別來自該等電腦裝置且分別對應該等被保險人的該等要保資料,並對該等要保資料執行檢核,以產生包括檢核成功的該等要保資料的一檢核名冊,並對該檢核名冊的每一該要保資料所對應的一繳款方式執行對應扣繳一加入費用,以產生包括扣繳成功的該等要保資料的一已繳加入費用名冊,該加入費用的金額等於該已繳加入費用。在步驟(a)中,該互助保險系統根據該檢核名冊及該已繳加入費用名冊,產生並儲存初始的該團險名冊。In some implementation aspects, the mutual insurance method further includes step (e) before step (a). Initially, the mutual insurance system is based on the respective computer devices corresponding to the insured persons. The required information, and the inspection of the required information is performed to generate a check list including the required information that has been successfully checked, and a corresponding one of the required information in the check list The payment method is executed corresponding to the withholding of a joining fee to generate a paid joining fee list including the required insurance materials for which the withholding is successful, and the amount of the joining fee is equal to the paid joining fee. In step (a), the mutual insurance system generates and stores the initial group insurance roster based on the check roster and the paid-in fee roster.
在一些實施態樣中,其中,在步驟(a)中,該團險名冊所對應的保險期間是從一起始日開始的一年。在步驟(e)中,該互助保險系統對在該起始日加入該檢核名冊的每一該被保險人所對應的該繳款方式執行對應扣繳該加入費用。該互助保險方法還包含步驟(f),在該年之內,該互助保險系統根據來自該任何一個該電腦裝置且對應該被保險人的該要保資料,並對該要保資料執行檢核,以產生包括檢核成功的該要保資料的該檢核名冊,且對該檢核名冊的該要保資料所對應的該繳款方式執行對應扣繳該加入費用,以產生包括扣繳成功的該要保資料的該已繳加入費用名冊,並再根據該檢核名冊及該已繳加入費用名冊,產生且儲存更新的該團險名冊。In some implementation aspects, in step (a), the insurance period corresponding to the group insurance roster is one year from a starting date. In step (e), the mutual insurance system performs corresponding deduction of the joining fee for the payment method corresponding to each insured who joined the check list on the starting date. The mutual insurance method also includes step (f). Within the year, the mutual insurance system performs a check on the insurance information from any of the computer devices and corresponding to the insured information. , To generate the inspection roster including the required insurance materials that have been successfully inspected, and execute the corresponding payment method corresponding to the insurance information of the inspection roster to withhold the joining fee, so as to generate including the successful withholding The paid-in fee list of the required insurance information, and then based on the check list and the paid-in fee list, generate and store the updated group insurance list.
在一些實施態樣中,該互助保險方法還包含步驟(g),該互助保險系統在該年的最後一日,根據當日的該團險名冊及該年之內的所有該分攤費用,計算該團險名冊中每一該被保險人所要繳納的一年繳保費差額,並產生對應的一最後繳費指令,且於收到該團險名冊中每一該被保險人的該年繳保費差額後給付該團險的一經驗退費,每一該被保險人的該年繳保費差額等於該預定年繳保費減去該加入費用,再減去該被保險人在該年之內所有該分攤費用之總和,該團險的該經驗退費等於K*(應繳保費之收入-營業費用-理賠支出)-前N年度之累積虧損。In some implementation aspects, the mutual insurance method further includes step (g). On the last day of the year, the mutual insurance system calculates the mutual insurance system based on the group insurance roster on that day and all the shared expenses in the year. The difference in premiums paid in one year for each insured in the group insurance roster, and a corresponding final payment instruction is generated, and after receiving the difference in premiums paid in that year for each insured in the group insurance roster For an experience refund for the group insurance, the difference in premiums paid in that year for each insured person is equal to the scheduled annual premium paid minus the joining fee, minus all the shared expenses of the insured during the year The sum of the experience refunds for the group insurance is equal to K* (income from premiums payable-operating expenses-claims expenses)-accumulated losses in the previous N years.
在一些實施態樣中,該互助保險方法還包含步驟(h),當該互助保險系統接收到來自該電腦裝置之其中一者在一退出日的一退出申請時,計算對應該電腦裝置的該被保險人的一應繳保費與一實繳保費的一差值,並在判斷該差值小於零時,產生金額對應該差值的一退款指令,而在判斷該差值大於等於零時,且再決定在該退出日之前的一欠繳保費總額與該差值之其中最小者等於一補收金額,以產生金額對應該補收金額的一補收指令。該實繳保費等於對應的該被保險人的該加入費用及該已繳分攤費用之總和。該互助保險系統還根據該退出申請,於該退出日的翌日零時起刪除該團險名冊中對應該被保險人的該要保資料,以產生並儲存更新的該團險名冊。In some embodiments, the mutual insurance method further includes step (h). When the mutual insurance system receives a withdrawal application from one of the computer devices on a withdrawal date, calculate the corresponding computer device A difference between a premium payable by the insured and an actual premium paid, and when it is judged that the difference is less than zero, a refund instruction of the amount corresponding to the difference is generated, and when it is judged that the difference is greater than or equal to zero, And then it is determined that the smallest of the total amount of outstanding premiums before the withdrawal date and the difference is equal to a supplementary payment amount, so as to generate a supplementary payment instruction for the amount corresponding to the supplementary payment amount. The actually paid premium is equal to the sum of the corresponding insured's joining fee and the paid apportionment fee. The mutual insurance system also deletes the insured information corresponding to the insured person in the group insurance register from the group insurance register according to the withdrawal application from 0:00 on the day following the withdrawal date, so as to generate and store an updated group insurance register.
本發明的功效在於:藉由該保費子系統在每日計算當日的該分攤費用,使得參加互助保險的該等被保險人在其中有出險者申請理賠(即該理賠資料)時,才收到對應的繳費通知(即該繳交保費指令且所對應的金額是該分攤費用),因而能夠不必像習知保險所必要的定期繳交固定金額的模式。The effect of the present invention is that the premium subsystem calculates the apportioned cost on the day every day, so that the insured who participates in the mutual insurance will receive the claim only when one of the insured persons applies for the claim (that is, the claim data) The corresponding payment notice (that is, the premium payment instruction and the corresponding amount is the share of the cost), so it is not necessary to pay a fixed amount on a regular basis, which is necessary for conventional insurance.
在本發明被詳細描述之前,應當注意在以下的說明內容中,類似的元件是以相同的編號來表示。Before the present invention is described in detail, it should be noted that in the following description, similar elements are denoted by the same numbers.
參閱圖1,本發明互助保險系統100之一實施例,適用於多個電腦裝置91、92,並包含一核保子系統1、一理賠子系統2、一保費子系統3、一資料庫4、及一網路服務系統5。該等電腦裝置91、92分別對應多個使用者,並例如是智慧型手機、平板電腦、或其他具備連網功能的電腦設備。另外,為使圖式簡單清楚起見,圖1僅示例性繪出兩個電腦裝置91、92,並不以此為數量的限制。Referring to FIG. 1, an embodiment of the
該互助保險系統100屬於一保險公司。該網路服務系統5例如提供網頁服務,以讓該等電腦裝置91、92建立連線而經由網路作資訊的存取,且電連接該核保子系統1及該保費子系統3。該理賠子系統2電連接該核保子系統1及該保費子系統3。該資料庫4電連接該理賠子系統2、該核保子系統1、及該保費子系統3。該核保子系統1、該理賠子系統2、該保費子系統3、該資料庫4、及該網路服務系統5之其中任一者例如是該保險公司的一個或多個伺服主機、雲端伺服器、大型電腦主機、或其他電腦設備,且其間例如以網路線形成電連接。The
參閱圖1與圖2,圖2是該互助保險系統100所實施的互助保險方法的一種態樣,該互助保險方法包含步驟S1~S8。1 and FIG. 2, FIG. 2 is an aspect of the mutual insurance method implemented by the
於步驟S1,初始時,該核保子系統1根據分別來自該等電腦裝置91、92之其中部分者且分別對應多個被保險人的多個要保資料,並對該等要保資料執行檢核,以產生包括檢核成功的該等要保資料的一檢核名冊。該保費子系統3接收該檢核名冊,並在一起始日時,對該檢核名冊的每一該要保資料所對應的一繳款方式執行對應扣繳一加入費用,以產生包括扣繳成功的該等要保資料的該已繳加入費用名冊。In step S1, initially, the underwriting subsystem 1 performs inspections on the insured data based on the insured data from some of the
舉例來說,1萬個被保險人都屬於同一個企業的員工,並分別使用其電腦裝置91、92經由該網路服務系統5提供1萬筆要保資料,以加入該互助保險系統100所提供的一互助保險,如初次罹患特定癌症保險。該核保子系統1對每一該要保資料作相關於該被保險人的年齡、保額、健康聲明、重大理賠歷史、事查證、除外項目、洗錢防治等等的檢核。例如全部都通過檢核,則該檢核名冊包含該1萬筆要保資料。每一該要保資料例如還包含信用卡授權書等資訊(即該繳款方式),該加入費用是預先設定,例如是50元。For example, 10,000 insured persons belong to employees of the same company, and use their
於步驟S2,該核保子系統1根據該檢核名冊及該已繳加入費用名冊,產生初始的一團險名冊,並將該團險名冊儲存於該資料庫4。該團險名冊包含分別對應該等被保險人的該等要保資料,且該團險名冊所對應的保險期間例如是從該起始日開始的一年。In step S2, the underwriting subsystem 1 generates an initial group insurance list based on the check list and the paid-in fee list, and stores the group insurance list in the
於步驟S3,在該年之內,該核保子保險系統根據來自該任何一個該電腦裝置91、92且對應該被保險人的該要保資料,並對該要保資料執行檢核,以產生(即更新)包括檢核成功的該要保資料的該檢核名冊。該保費子系統3對該檢核名冊的該要保資料所對應的該繳款方式執行對應扣繳該加入費用,以產生包括扣繳成功的該要保資料的該已繳加入費用名冊。該核保子系統1再根據該檢核名冊及該已繳加入費用名冊,產生更新的該團險名冊,且將該團險名冊儲存於該資料庫4。換句話說,在該起始日之後,任何一個要加入該互助保險的被保險人,例如該企業的新進員工,都例如要在加入的當天,繳交該加入費用,如50元。In step S3, within the year, the underwriting sub-insurance system performs a check on the insured data from any of the
於步驟S4,該理賠子系統2根據該等電腦裝置91、92之其中至少一者所對應的至少一理賠資料,執行理賠審核,以產生通過理賠審核的一當日總理賠金額及一給付理賠指令,每一該理賠資料對應該團險名冊的該等被保險人之其中一者。舉例來說,該核保子系統1對每一該理賠資料作相關於出險的該被保險人的理賠紀錄、不給付紀錄、特殊紀錄、預付金紀錄、醫鑑紀錄、洗錢高風險名單等等的審核,並將當日所有通過理賠審核的理賠金額之加總,而獲得該當日總理賠金額,該給付理賠指令藉由對應的該要保資料所提供的給付方式例如是執行對應的匯款。In step S4, the
於步驟S5,該保費子系統3每日計算該當日總理賠金額除以該團險名冊中所對應的有效被保險人總數,而獲得當日的一分攤費用,且產生分別對應該團險名冊中的該等被保險人的多個繳交保費指令,每一該繳交保費指令所對應的金額是該分攤費用,該分攤費用之上限為該被保險人的該預定年繳保費減去扣除該被保險人的該已繳加入費用,再減去該被保險人的該已繳分攤費用(不含當次)。舉例來說,在該年之內的某一天,提出理賠申請的該被保險人總共只有1位,該團險名冊中所對應的有效被保險人總數為1萬個人,假設該當日總理賠金額為30萬元,則該分攤費用等於30元(即30萬元/1萬個人)。每一該繳交保費指令藉由對應的該要保資料所包含的繳款方式(如信用卡授權書等資訊)執行對應的扣款。In step S5, the
於步驟S6,該核保子系統1根據通過理賠審核的該至少一理賠資料及該團險名冊,於理賠審核日的翌日零時起刪除該團險名冊中已通過理賠審核的該至少一被保險人所對應的該至少一要保資料,以產生更新的該團險名冊,並將該團險名冊儲存於該資料庫4。也就是說,該互助保險的保險契約對出險的該被保險人效力已終止。In step S6, the underwriting subsystem 1 deletes the at least one insured group that has passed the claims review from the group insurance list at midnight on the day following the claim review date based on the at least one claim data and the group insurance list that have passed the claim review The at least one insurance data corresponding to the person is used to generate an updated group insurance roster, and the group insurance roster is stored in the
於步驟S7,當該保費子系統3接收到來自該電腦裝置91、92之其中一者在一退出日的一退出申請時,計算對應該電腦裝置91、92的該被保險人的一應繳保費與一實繳保費的一差值,並在判斷該差值小於零時,產生金額對應該差值的一退款指令,而在判斷該差值大於等於零時,且再決定在該退出日之前的一欠繳保費總額與該差值之其中最小者等於一補收金額,以產生金額對應該補收金額的一補收指令。該實繳保費等於對應的該被保險人的該加入費用及該已繳分攤費用之總和。該核保子系統1還根據該退出申請,於該退出日的翌日零時起刪除該團險名冊中對應該被保險人的該要保資料,以產生並儲存更新的該團險名冊。該退款指令及該補收指令分別與該給付理賠指令及該繳交保費指令的運作方式相似。舉例來說,該應繳保費之計算為該預定年繳保費(如365元)*(Min(退出生效日期,契約終止日期)-加入日期)/(契約終止日期-契約生效日期)。本商品(即該互助保險)為團體保險,契約生效日為該契約簽訂時的生效日期,加入日期為各被保險人加保的日期。In step S7, when the
於步驟S8,該保費子系統3在該年的最後一日,根據當日的該團險名冊及該年之內的所有該分攤費用,計算該團險名冊中每一該被保險人所要繳納的一年繳保費差額,並產生對應的一最後繳費指令,且於收到該團險名冊中每一該被保險人的該年繳保費差額後,給付該團險的一經驗退費。每一該被保險人的該年繳保費差額等於該預定年繳保費減去該加入費用,再減去該被保險人在該年之內所有該分攤費用之總和。該團險(即該互助保險)的該經驗退費等於K*(應繳保費之收入-營業費用-理賠支出)-前N年度之累積虧損,K大於等於0且小於等於100%,N等於0或正整數。該最後繳費指令與該繳交保費指令的運作方式相似。舉例來說,該預定年繳保費是365元,假設整年都沒有任何被保險人出險,則該年繳保費差額為365減去50等於315元。又例如假設其中一個該被保險人在整年的該分攤費用等於257元,則該年繳保費差額為365減去50及257等於58元。該應繳保費之收入是指各被保險人於該年度之保險期間所對應的該等應繳保費的合計之值,例如該年度無人中途加退保,且所有被保險人保險期間均為365日,且各被保險人該年度應繳保費為365元,則該年度的該經驗退費所採計的該應繳保費之收入為365元乘以被保險人總數;K值範圍為0~100%(本例為100%),N值為大於等於零的整數(本例第一年為0,第二年為1,第三年為2,以此類推)。In step S8, on the last day of the year, the
另外要特別補充說明的是:步驟S7也可以放置在步驟S3~S6之間的任何兩相鄰步驟之間,或者,步驟S3也可以放置在步驟S4~S7之間的任何兩相鄰步驟之間,都不影響該互助保險方法的實施與運作。同樣地,In addition, it should be noted that step S7 can also be placed between any two adjacent steps between steps S3 and S6, or step S3 can also be placed between any two adjacent steps between steps S4 and S7. In the meantime, it will not affect the implementation and operation of the mutual insurance method. Similarly,
綜上所述,藉由該保費子系統先在該起始日對每一該被保險人收取該加入費用,且在每日且其中該至少一被保險人提出理賠且通過時,計算當日的該分攤費用,使得參加互助保險的該等被保險人在出險時,才收到對應的繳費通知(即該繳交保費指令且所對應的金額是該分攤費用),最後在該年的最後一日繳交該年繳保費差額。該互助保險系統及方法不但不必像習知保險般地定期繳交固定金額,且所實施的該互助保險是以團體保險的架構來運作,並以團體保險所特有的該經驗退費來達成實質互助循環,而增加企業為其員工投保的誘因,因而能夠運用團險商品可議價及經驗退費之特性,進一步達成一種新的全體風險分攤的概念,故確實能達成本發明的目的。In summary, the premium subsystem first collects the joining fee from each insured on the starting date, and when at least one of the insured files a claim every day and passes, calculate the current day’s The cost-sharing allows those insureds who participate in mutual insurance to receive the corresponding payment notice (that is, the payment instruction and the corresponding amount is the cost-sharing) when the insured is out of risk, and finally at the last of the year The difference in premiums paid for that year is paid daily. The mutual insurance system and method not only do not need to pay a fixed amount regularly like conventional insurance, but the implemented mutual insurance is operated in the structure of group insurance, and the experience rebates that are unique to group insurance are used to achieve the essence. Mutual assistance cycle, and increase the incentives for companies to insure their employees, so they can use the characteristics of group insurance products to be negotiated and experience refunds to further achieve a new concept of overall risk sharing, so it can indeed achieve the purpose of cost invention.
惟以上所述者,僅為本發明的實施例而已,當不能以此限定本發明實施的範圍,凡是依本發明申請專利範圍及專利說明書內容所作的簡單的等效變化與修飾,皆仍屬本發明專利涵蓋的範圍內。However, the above are only examples of the present invention. When the scope of implementation of the present invention cannot be limited by this, all simple equivalent changes and modifications made in accordance with the scope of the patent application of the present invention and the content of the patent specification still belong to Within the scope covered by the patent of the present invention.
100:互助保險系統 1:核保子系統 2:理賠子系統 3:保費子系統 4:資料庫 5:網路服務系統 91:電腦裝置 92:電腦裝置 S1~S8:步驟100: Mutual Insurance System 1: Underwriting subsystem 2: Claims Subsystem 3: Premium Subsystem 4: Database 5: Internet service system 91: computer device 92: computer device S1~S8: steps
本發明的其他的特徵及功效,將於參照圖式的實施方式中清楚地呈現,其中: 圖1是一方塊圖,說明本發明互助保險系統的一實施例;及 圖2是一流程圖,說明本發明互助保險系統的該實施例所實施的互助保險方法。Other features and effects of the present invention will be clearly presented in the embodiments with reference to the drawings, in which: Figure 1 is a block diagram illustrating an embodiment of the mutual insurance system of the present invention; and Fig. 2 is a flowchart illustrating the mutual insurance method implemented by the embodiment of the mutual insurance system of the present invention.
100:互助保險系統100: Mutual Insurance System
1:核保子系統1: Underwriting subsystem
2:理賠子系統2: Claims Subsystem
3:保費子系統3: Premium Subsystem
4:資料庫4: Database
5:網路服務系統5: Internet service system
91:電腦裝置91: computer device
92:電腦裝置92: computer device
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