TWI785304B - Mutual insurance system and mutual insurance method - Google Patents

Mutual insurance system and mutual insurance method Download PDF

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TWI785304B
TWI785304B TW109102717A TW109102717A TWI785304B TW I785304 B TWI785304 B TW I785304B TW 109102717 A TW109102717 A TW 109102717A TW 109102717 A TW109102717 A TW 109102717A TW I785304 B TWI785304 B TW I785304B
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insurance
insured
premium
fee
generate
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TW202129586A (en
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翁健峰
吳苗華
林育名
郭馥綺
林冠毅
李維剛
王羽萱
歐東彥
蕭楓穎
沈家揚
許鼎正
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國泰人壽保險股份有限公司
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一種互助保險系統包含一資料庫、一理賠子系統、一保費子系統、及一核保子系統。該資料庫儲存一團險名冊,該理賠子系統審核理賠申請並計算一當日總理賠金額,該保費子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。該核保子系統於理賠審核日之翌日零時起刪除該團險名冊中已通過理賠審核的該要保資料,以產生並儲存於該資料庫的更新的該團險名冊。藉此,而能夠實施管理互助保險的一種互助保險方法。A mutual insurance system includes a database, a claim settlement subsystem, a premium subsystem, and an underwriting subsystem. The database stores a group insurance register, the claims subsystem reviews the claims application and calculates the general claim amount of the day, and the premium subsystem calculates the daily general claim amount divided by the corresponding effective insured in the group insurance register The total amount is obtained to obtain an apportionment of the current day, and generate multiple premium payment instructions respectively corresponding to the insureds in the group insurance register. The underwriting subsystem deletes the insurance request data that has passed the claim review from the group insurance register at 00:00 on the day following the claim review date, so as to generate and store the updated group insurance register in the database. Thereby, a mutual insurance method of managing mutual insurance can be implemented.

Description

互助保險系統及互助保險方法Mutual insurance system and mutual insurance method

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 present 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 match the product structure, adopt annual, quarterly, or monthly regular payment methods, and determine each payment rate through actuarial pricing. Furthermore, the payment obligation of the policyholder has nothing to do with the actual claim settlement status of the commodity. 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 becomes 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 object 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 an aspect of the present invention, a mutual insurance system is provided, which is applicable to multiple computer devices and includes a database, a claim 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 a plurality of insurance requirements corresponding to a plurality of insureds. The claim settlement subsystem is electrically connected to the database, and performs claim settlement review based on at least one claim settlement data corresponding to at least one of the computer devices, so as to generate a daily general claim amount and a payment claim settlement instruction that pass the claim settlement review, Each claim information corresponds to one of the insureds in the group insurance register.

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 claim settlement subsystem and the database, and calculates the general claim amount of the day divided by the total number of valid insureds corresponding to the group insurance roster on a daily basis to obtain an apportionment of the day, and generates Multiple premium payment instructions respectively corresponding to the insureds in the group insurance register. The amount corresponding to each premium payment instruction is the apportionment fee, and the upper limit of the apportionment fee corresponding to each insured person is the insured person’s scheduled annual premium minus the insured person’s paid The entry fee, minus a paid contribution for that insured.

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 claim subsystem, and based on the at least one claim data that has passed the claim review and the group insurance register, deletes the claims that have passed the group insurance register from the group insurance register at 00:00 on the day following the claim review date The at least one insured information corresponding to the at least one insured person reviewed is generated and stored in the updated group insurance register 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 implementation aspects, wherein, initially, the underwriting subsystem checks the claim data according to the claim data respectively from the computer devices and respectively corresponding to the insured persons, so as to Generate a verification list including the insurance information that has been verified successfully, and generate the initial group insurance list based on the verification list and a paid entry fee list, and store the group insurance list in the database . The premium subsystem is electrically connected to the underwriting subsystem to receive the verification list, and perform a corresponding withholding and payment of a payment method corresponding to each of the insurance data in the verification list, so as to generate a fee including deduction The paid accession fee register of the data to be protected is successfully paid, and the amount of the accession fee is equal to the paid accession 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 implementations, wherein the insurance period corresponding to the group insurance register is one year from a start date, the premium subsystem checks each insured person who joins the check register on the start date The corresponding payment method executes corresponding withholding of the joining fee. Within the year, the underwriting subsystem checks the claim data according to the claim data from any one of the computer devices and corresponds to the insured, so as to generate the claim data including the successful verification The checklist of data. The premium subsystem executes the corresponding withholding of the entry fee for the payment method corresponding to the required information in the verification list, so as to generate the paid entry fee list including the successfully withheld the required information. The underwriting subsystem then generates an updated group insurance register based on the verification register and the paid membership register, 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 each insured in the group insurance list on the last day of the year based on the group insurance list on that day and all the apportioned expenses in the year. The premium difference of the year to be paid by the individual, and a corresponding final payment instruction is generated, and an experience refund of the group insurance is paid after receiving the difference of the annual premium payment of each insured person in the group insurance roster , the annual premium difference of each insured is equal to the predetermined annual premium minus the joining fee, minus the sum of all the apportioned expenses of the insured in that year, the experience of the group insurance The refund is equal to K*(income of premium payable-operating expenses-claim settlement expenses)-accumulated losses in 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 implementation aspects, wherein, when the premium subsystem receives a withdrawal application from one of the computer devices on a withdrawal date, it calculates a payable premium of the insured corresponding to the computer device and A difference in premium paid, and when it is judged that the difference is less than zero, a refund instruction with an amount corresponding to the difference is generated; The minimum of the difference between the total amount of premiums owed and the difference is equal to an overpayment amount, so as to generate an overpayment instruction with an amount corresponding to the overpayment amount. The paid premium is equal to the sum of the joining fee and the apportioned fee of the corresponding insured. According to the withdrawal application, the underwriting subsystem deletes the insurance request data corresponding to the insured in the group insurance register at 00:00 on the day following the withdrawal date, so as 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)-(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), a group insurance register corresponding to a group insurance is stored by the mutual insurance system, and the group insurance register includes multiple insurance requirements corresponding to multiple insureds.

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 daily general claim amount and a payment claim instruction that pass the claim review , each claim information corresponds to one of the insureds in the group insurance register.

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 general claim amount of the day divided by the total number of valid insured persons corresponding to the group insurance roster to obtain an apportioned expense on the day, and generate corresponding group Multiple premium payment instructions of the insured in the insurance register, the amount corresponding to each premium payment instruction is the apportioned expense, and the upper limit of the apportioned expense corresponding to each insured is the insured A scheduled annual premium for a person minus a paid enrollment fee for the insured person, less a contributed contribution for the insured person.

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), the mutual insurance system deletes the at least one claim that has passed the claim audit from the group insurance register at 00:00 on the day following the claim audit date based on the at least one claim that has passed the claim audit and the group insurance register. The at least one insurance information corresponding to an insured person is used to generate and store an updated group insurance register.

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 implementations, the mutual insurance method further includes step (e) before step (a). Initially, the mutual insurance system according to the The data to be protected, and check the data to be protected, so as to generate a check list including the data to be protected that has been successfully checked, and a corresponding one of the data to be protected in the check list The payment method executes corresponding withholding of an accession fee, so as to generate a paid accession fee list including the successfully withheld data to be protected, and the amount of the accession fee is equal to the paid accession fee. In step (a), the mutual insurance system generates and stores the initial group insurance register according to the verification register and the paid membership register.

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, wherein, in step (a), the insurance period corresponding to the group insurance register is one year from a start date. In step (e), the mutual insurance system performs the corresponding withholding 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 further includes step (f), within the year, the mutual insurance system performs a check on the insurance information according to the insurance information from any one of the computer devices and corresponding to the insured , to generate the verification roster including the information to be protected that has been successfully verified, and perform the corresponding withholding of the joining fee for the payment method corresponding to the information to be protected in the verification roster, so as to generate information including the successfully withheld The paid enrollment fee register of the insured information, and then generate and store an updated group insurance register based on the verification register and the paid enrollment fee register.

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 implementations, the mutual insurance method further includes step (g), the mutual insurance system calculates the mutual insurance system on the last day of the year based on the group insurance register on that day and all the apportioned expenses in the year The balance of premiums to be paid by each insured in the group insurance roster for one year, and a corresponding final payment instruction is generated, and after receiving the difference in premiums paid by each insured in the group insurance roster for that year An experience refund for the group insurance is paid, and the difference in the annual premium payment of each insured is equal to the scheduled annual premium minus the joining fee, minus all the apportioned expenses of the insured within the year The sum of the experience refunds of the group insurance is equal to K*(income of payable premiums-operating expenses-claim settlement expenses)-accumulated losses of 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 implementations, 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, calculating the corresponding computer device A difference between a payable premium and an actually paid premium of the insured, and when it is judged that the difference is less than zero, a refund instruction with an amount corresponding to the difference is generated, and when it is judged that the difference is greater than or equal to zero, Furthermore, it is determined that the minimum of the difference between the total amount of outstanding premiums and the difference before the withdrawal date is equal to a supplementary payment amount, so as to generate a supplementary collection order with an amount corresponding to the supplementary collection amount. The paid premium is equal to the sum of the joining fee and the apportioned fee of the corresponding insured. The mutual insurance system also deletes the insurance request data corresponding to the insured in the group insurance register at 00:00 on the next day of the exit date according to the withdrawal application, 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 lies in that: the sub-system of the premium calculates the apportioned expenses of the day on a daily basis, so that the insureds who participate in the mutual insurance only receive it when there is an out-of-risk person applying for a claim (that is, the claim data). The corresponding premium payment notice (that is, the premium payment instruction and the corresponding amount is the apportionment of expenses), therefore, it is not necessary to regularly pay a fixed amount of money like 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 numerals.

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, one embodiment of the mutual insurance system 100 of the present invention is applicable to a plurality of computer devices 91, 92, and includes an underwriting subsystem 1, a claim settlement subsystem 2, a premium subsystem 3, a database 4, And a network service system 5. The computer devices 91 and 92 respectively correspond to a plurality of users, and are, for example, smart phones, tablet computers, or other computer devices with networking functions. In addition, for the sake of simplicity and clarity of the drawing, FIG. 1 only shows two computer devices 91 and 92 as an example, which is not intended as a limitation on the number.

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 mutual insurance system 100 belongs to an insurance company. The network service system 5 provides web services, for example, to allow the computer devices 91 and 92 to establish connections to access information via the network, and to electrically connect the underwriting subsystem 1 and the premium subsystem 3 . The claim settlement subsystem 2 is electrically connected to the underwriting subsystem 1 and the premium subsystem 3 . The database 4 is electrically connected to the claim settlement subsystem 2 , the underwriting subsystem 1 , and the premium subsystem 3 . Any one of the underwriting subsystem 1, the claim settlement subsystem 2, the premium subsystem 3, the database 4, and the network service system 5 is, for example, one or more server hosts or cloud servers of the insurance company. servers, mainframe computers, or other computer equipment, and are electrically connected, for example, with network cables.

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。Referring to FIG. 1 and FIG. 2, FIG. 2 is an example of a mutual insurance method implemented by the mutual insurance system 100, and the mutual insurance method includes steps S1-S8.

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 executes a check on the required data according to a plurality of required data from some of the computer devices 91, 92 and corresponding to a plurality of insured persons respectively. verification, so as to generate a verification register including the data to be protected that has been verified successfully. The premium subsystem 3 receives the verification list, and at the beginning of the day, performs a corresponding withholding of a payment method corresponding to each of the required data in the verification list to generate a fee including a successful withholding The paid entry fee register for the required data.

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 insureds are all employees of the same enterprise, and they use their computer devices 91 and 92 to provide 10,000 pieces of information to be insured through the network service system 5 to join the mutual insurance system 100 Mutual insurance provided, such as first-time specific cancer insurance. The underwriting subsystem 1 checks each insured information related to the insured's age, insurance amount, health statement, major claim history, event verification, excluded items, money laundering prevention and so on. For example, if all pass the inspection, the inspection list includes the 10,000 pieces of data to be preserved. For example, each of the required data also includes credit card authorization letter and other information (that is, the payment method), and the adding fee is preset, for example, 50 yuan.

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 register based on the verification register and the paid registration fee register, and stores the group insurance register in the database 4 . The group insurance register includes the insurance requirements corresponding to the insureds, and the insurance period corresponding to the group insurance register is, for example, one year from the start date.

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 checks the insurance request data from any one of the computer devices 91, 92 and corresponds to the insured person, to generate (that is, update) the check list including the data to be protected that have been successfully checked. The premium subsystem 3 executes the corresponding withholding of the entry fee for the payment method corresponding to the required information in the verification list, so as to generate the paid entry fee list including the successfully withheld information required for protection. The underwriting subsystem 1 then generates an updated group insurance register based on the verification register and the paid membership register, and stores the group insurance register in the database 4 . In other words, after the starting date, any insured person who wants to join the mutual insurance, such as a new employee of the enterprise, must pay the joining fee, such as 50 yuan, on the day of joining.

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 claim settlement subsystem 2 executes a claim settlement review based on at least one claim settlement data corresponding to at least one of the computer devices 91, 92 to generate a daily general claim amount and a payment claim settlement instruction that pass the claim settlement review , each claim information corresponds to one of the insureds in the group insurance register. For example, the underwriting subsystem 1 records the claim records, non-payment records, special records, advance payment records, medical records, money laundering high risk lists, etc. Review, and sum up all the claims that have passed the claim review on the day to obtain the total claim amount on the day. The payment and claim instruction uses the payment method provided by the corresponding insurance information, for example, to execute the corresponding remittance.

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 premium sub-system 3 calculates the general claim amount of the day and divides it by the total number of valid insureds corresponding to the group insurance roster to obtain an apportionment of the day, and generates the sums respectively corresponding to the group insurance roster. Multiple premium payment instructions of the insured, the amount corresponding to each premium payment instruction is the apportionment fee, and the upper limit of the appropriation fee is the scheduled annual premium of the insured minus the deduction of the The insured's paid entry fee, minus the insured's paid apportionment fee (excluding the current one). For example, on a certain day in the year, there is only one insured who applies for claims, and the total number of valid insureds corresponding to the group insurance roster is 10,000, assuming that the total claim amount on that day If it is 300,000 yuan, the apportioned cost is equal to 30 yuan (that is, 300,000 yuan/10,000 individuals). Each premium payment instruction executes the corresponding deduction through the payment method (such as credit card authorization letter and other information) contained in the corresponding insurance information.

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 that has passed the claim review from the group insurance list at 00:00 on the day following the claim review date based on the at least one claim that has passed the claim review and the group insurance register. The at least one insurance information corresponding to the person is generated to generate an updated group insurance register, and the group insurance register is stored in the database 4 . That is to say, the insurance contract of the mutual aid insurance has terminated the validity of the insured who is in danger.

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 premium subsystem 3 receives a withdrawal application from one of the computer devices 91, 92 on a withdrawal date, calculate a payable amount of the insured corresponding to the computer device 91, 92 A difference between the premium and an actual paid premium, and when it is judged that the difference is less than zero, a refund instruction with an amount corresponding to the difference is generated, and when it is judged that the difference is greater than or equal to zero, and then decided The minimum of the difference between the previous total amount of unpaid premiums and the difference is equal to an overpayment amount, so as to generate an overpayment instruction whose amount corresponds to the overpayment amount. The paid premium is equal to the sum of the joining fee and the apportioned fee of the corresponding insured. The underwriting subsystem 1 also deletes the insurance request data corresponding to the insured in the group insurance register at 00:00 on the next day of the exit date according to the withdrawal application, so as to generate and store an updated group insurance register. The operation modes of the refund instruction and the supplementary payment instruction are similar to the payment and claim settlement instruction and the premium payment instruction respectively. For example, the calculation of the payable premium is the scheduled annual premium (such as 365 yuan) * (Min (withdrawal effective date, contract termination date) - joining date) / (contract termination date - contract effective date). This product (that is, the mutual insurance) is a group insurance, the effective date of the contract is the effective date when the contract is signed, and the joining date is the date when each insured adds insurance.

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, the premium subsystem 3 calculates the amount to be paid by each insured in the group insurance list on the last day of the year, based on the group insurance list on that day and all the apportioned expenses in the year Pay the premium difference for one year, and generate a corresponding final payment instruction, and pay an experience refund for the group insurance after receiving the premium payment difference for each insured person in the group insurance roster for that year. The annual premium difference for each insured is equal to the scheduled annual premium minus the enrollment fee, minus the sum of all of the insured's apportioned charges for that year. The experience refund of the group insurance (that is, the mutual insurance) is equal to K*(income of payable premiums-operating expenses-claim expenses)-accumulated losses in 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. The last premium payment order operates similarly to the premium payment order. For example, the scheduled annual premium payment is 365 yuan. Assuming that no insured person is in danger throughout the year, the difference in the annual premium payment is 365 minus 50, which equals 315 yuan. Another example is assuming that one of the insured's apportioned expenses in the whole year is equal to 257 yuan, then the difference in the annual premium payment is 365 minus 50 and 257 equals 58 yuan. The income of the premiums payable refers to the total value of the premiums payable corresponding to the insurance period of each insured person in the year, for example, no one surrenders the policy halfway in the year, and the insurance period of all the insured persons is 365 day, and the premium payable by each insured person for that year is 365 yuan, then the income of the payable premium calculated for the experience refund in that year is 365 yuan multiplied by the total number of insured persons; the K value ranges from 0 to 100% (100% in this example), N is an integer greater than or equal to zero (in this example, the first year is 0, the second year is 1, the third year is 2, and so on).

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 specially added that step S7 can also be placed between any two adjacent steps between steps S3~S6, or step S3 can also be placed between any two adjacent steps between steps S4~S7. 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。To sum up, the premium subsystem first collects the joining fee from each insured person on the starting date, and calculates the daily payment when at least one insured person submits a claim and passes it. The apportionment of expenses enables the insured who participate in mutual insurance to receive the corresponding payment notice (that is, the instruction to pay the premium and the corresponding amount is the apportionment of expenses) when the insured who participates in the mutual insurance is in danger, and finally on the last day of the year Pay the difference in premiums paid for the year. The mutual insurance system and method not only do not need to pay a fixed amount regularly like conventional insurance, but also implement the mutual insurance to operate under the structure of group insurance, and realize the actual refund by the unique experience of group insurance. Mutual aid circulation increases the incentives for companies to insure their employees, so that the characteristics of negotiable prices and experience refunds for group insurance products can be used to further achieve a new concept of overall risk sharing, so the purpose of the present invention can indeed be achieved.

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。But the above-mentioned ones are only embodiments of the present invention, and should not limit the scope of the present invention. All simple equivalent changes and modifications made according to the patent scope of the present invention and the content of the patent specification are still within the scope of the present invention. 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: Nuclear insurance subsystem 2: Claims Subsystem 3: Premium subsystem 4: Database 5: Network 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 implementation manner with reference to the drawings, wherein: 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: Nuclear insurance 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: Network service system

91:電腦裝置91:Computer device

92:電腦裝置92:Computer device

Claims (4)

一種互助保險系統,適用於多個電腦裝置,並包含:一資料庫,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;一理賠子系統,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;一保費子系統,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;及一核保子系統,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,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,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,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。 A mutual insurance system, which is applicable to multiple computer devices, and includes: a database storing a group insurance register corresponding to a group insurance, the group insurance register containing a plurality of insured information respectively corresponding to a plurality of insured persons; The claim settlement subsystem is electrically connected to the database, and performs claim settlement review based on at least one claim settlement data corresponding to at least one of the computer devices, so as to generate a daily general claim amount and a payment claim settlement instruction that pass the claim settlement review, Each claim data corresponds to one of the insureds in the group insurance roster; a premium subsystem, electrically connected to the claim subsystem and the database, and calculates the general claim amount of the day divided by the group The total number of valid insureds corresponding to the group insurance roster, to obtain a share of the cost of the day, and generate multiple premium payment instructions corresponding to the insureds in the group insurance roster, each premium payment instruction The corresponding amount is the apportionment fee, and the upper limit of the apportionment fee corresponding to each insured person is a predetermined annual premium of the insured person minus a paid entry fee of the insured person, minus the A paid apportionment of the insured; and an underwriting subsystem electrically connected to the database and the claim subsystem, and based on the at least one claim information and the group insurance register that have passed the claim review, on the day following the claim review date Delete the at least one insurance policy corresponding to the at least one insured who has passed the claim review in the group insurance register from zero o'clock, so as to generate and store the updated group insurance register in the database. Initially, the The underwriting subsystem, based on the insurance requirements data from the computer devices and corresponding to the insureds, and the insurance requirements Execute the verification of the materials to generate a verification list including the insured materials that have been verified successfully, and generate the initial group insurance list based on the verification list and a paid entry fee list, and transfer the group insurance The roster is stored in the database, and the premium subsystem is electrically connected to the underwriting subsystem to receive the verification roster, and perform a corresponding withholding for a payment method corresponding to each required information in the verification roster. Joining fee to generate the paid joining fee list including the information to be insured that has been withheld successfully, the amount of the joining fee is equal to the paid joining fee, and the insurance period corresponding to the group insurance list starts from the first starting date In the year of , the premium subsystem will carry out the corresponding withholding of the entry fee for the payment method corresponding to each insured who joined the verification list on the starting date. The system checks the claim data from any one of the computer devices and corresponds to the insured person, so as to generate the check list including the claim data that has been successfully checked, and the premium The sub-system executes corresponding withholding of the entry fee corresponding to the payment method corresponding to the required information in the verification list, so as to generate the paid entry fee list including the successfully withheld information required for protection. The underwriting subsystem Then, based on the verification list and the paid entry fee list, an updated group insurance list is generated and stored in the database. On the last day of the year, the premium subsystem, based on the group insurance list and the Calculate all the apportioned expenses within the year, calculate the difference in annual premiums to be paid by each insured person in the group insurance list, and generate a corresponding final payment instruction, and upon receipt of each insured person in the group insurance list After paying the premium difference of the year to the insured, an experience refund of the group insurance will be paid, each insured The difference of the insurer's annual premium payment is equal to the scheduled annual premium minus the joining fee, minus the sum of all the apportioned expenses of the insured within the year, and the experience refund of the group insurance is equal to K* (Premium Payable Income - Operating Expenses - Claim Expenses) - Accumulated losses in 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. 如請求項1所述的互助保險系統,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。 The mutual insurance system as described in claim 1, wherein, when the premium subsystem receives a withdrawal application from one of the computer devices on a withdrawal date, it calculates a corresponding to the computer device of the insured A difference between the payable premium and an actually paid premium, and when it is judged that the difference is less than zero, a refund instruction with an amount corresponding to the difference is generated, and when it is judged that the difference is greater than or equal to zero, and then decided The minimum of the difference between the total amount of arrears of premiums and the difference before the withdrawal date is equal to a repayment amount, so as to generate a recharge instruction with an amount corresponding to the amount of repayment. The paid premium is equal to the corresponding insured’s The sum of the enrollment fee and the paid apportionment fee. According to the withdrawal application, the underwriting subsystem deletes the insurance request information corresponding to the insured from the group insurance register at 00:00 on the day following the withdrawal date to generate and store The updated group insurance register in the database. 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,並包含下列步驟:(a)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,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一已繳加入費用,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;(b)藉由該互助保險系統根據該檢核名冊及該已繳加入費用名冊,產生並儲存初始的一對應一團險的團險名冊,該團險名冊包含分別對應該等被保險人的該等要保資料,該團險名冊所對應的保險期間是從一起始日開始的一年;(c)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;(d)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;(e)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該已繳加入費用,再減去該被保險人的一已繳分攤費用;(f)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;及(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,K大於等於0且小於等於100%,N等於0或正整數。 A mutual insurance method is applicable to multiple computer devices and a mutual insurance system, and includes the following steps: (a) initially, the mutual insurance system uses multiple The data to be protected, and check the data to be protected, so as to generate a check list including the data to be protected that has been successfully checked, and a corresponding one of the data to be protected in the check list The payment method executes the corresponding withholding one join fee to generate including the withholding A paid enrollment fee register of such claim data, the amount of which is equal to a paid enrollment fee, the mutual insurance system for each insured who is added to the check list on the starting date The corresponding payment method executes the corresponding withholding of the joining fee; (b) through the mutual insurance system, according to the verification list and the paid joining fee list, generate and store the initial one-to-one group insurance group insurance list , the group insurance register contains the insurance information corresponding to each of the insureds, and the insurance period corresponding to the group insurance register is one year from the starting date; (c) within that year, the mutual aid The insurance system checks the claim data from any one of the computer devices and corresponds to the insured person, so as to generate the check list including the claim data that has been successfully checked, and Execute corresponding withholding of the entry fee for the payment method corresponding to the required information in the verification list, so as to generate the paid entry fee list including the successfully withheld information required for protection, and then according to the verification register and the registered registration fee paid, generate and store the updated group insurance register; (d) perform claim settlement review through the mutual insurance system based on at least one claim data corresponding to at least one of the computer devices, To generate a daily general claim amount and a payment claim instruction that pass the claim review, and each claim data corresponds to one of the insureds in the group insurance register; (e) calculated daily by the mutual insurance system Divide the general claim amount on the day by the total number of valid insureds corresponding to the group insurance roster to obtain a shared expense on the day, and generate corresponding insureds in the group insurance roster Multiple premium payment instructions of the insurer, the amount corresponding to each premium payment instruction is the apportionment fee, and the upper limit of the apportionment fee corresponding to each insured person is a predetermined annual premium payment of the insured person Subtract the paid entry fee of the insured, and then subtract a paid contribution of the insured; (f) through the mutual insurance system, based on the at least one claim information that has passed the claim review and the group insurance roster, delete the at least one insurance policy corresponding to the at least one insured who has passed the claim review from the group insurance roster at 00:00 on the day following the claim review date, so as to generate and store an updated group insurance roster; and (g) On the last day of the year, the mutual insurance system calculates the yearly payment for each insured in the group insurance list based on the group insurance list on that day and all the apportioned expenses during the year Pay the premium difference, and generate a corresponding final payment instruction, and pay an experience refund for the group insurance after receiving the annual premium payment difference of each insured in the group insurance roster, and each insured The difference between the annual premium payment of the person is equal to the scheduled annual premium minus the joining fee, and then minus the sum of all the apportioned expenses of the insured within the year, and the experience refund of the group insurance is equal to K*( Income of payable premiums - operating expenses - claims expenses) - accumulated losses in 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. 如請求項3所述的互助保險方法,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。 The mutual insurance method as described in claim 3, further comprising step (h), when the mutual insurance system receives a withdrawal application from one of the computer devices on a withdrawal date, calculating the corresponding computer device The difference between a payable premium and a paid premium of the insured, and when it is judged that the difference is less than When it is zero, a refund instruction with an amount corresponding to the difference is generated, and when it is judged that the difference is greater than or equal to zero, it is determined that the minimum of the total amount of outstanding premiums before the exit date and the difference is equal to a supplement to generate a supplementary payment instruction with an amount corresponding to the supplementary payment amount, the paid premium is equal to the sum of the entry fee and the paid apportionment fee of the corresponding insured, and the mutual insurance system also bases on the withdrawal application , delete the insurance request data corresponding to the insured in the group insurance register from 00:00 on the next day of the withdrawal date, so as to generate and store an updated group insurance register.
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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
TW201801019A (en) * 2016-06-23 2018-01-01 馬梅銓 Mutual insuring method and mutual insurance system providing mutual insurance to a plurality of members in a mutual insurance group
TWM597470U (en) * 2020-01-30 2020-06-21 國泰人壽保險股份有限公司 Mutual insurance system

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* Cited by examiner, † Cited by third party
Publication number Priority date Publication date Assignee Title
TW201801019A (en) * 2016-06-23 2018-01-01 馬梅銓 Mutual insuring method and mutual insurance system providing mutual insurance to a plurality of members in a mutual insurance group
TWM597470U (en) * 2020-01-30 2020-06-21 國泰人壽保險股份有限公司 Mutual insurance system

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