WO2018184551A1 - 一种护理金赔付方法和装置 - Google Patents

一种护理金赔付方法和装置 Download PDF

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Publication number
WO2018184551A1
WO2018184551A1 PCT/CN2018/081826 CN2018081826W WO2018184551A1 WO 2018184551 A1 WO2018184551 A1 WO 2018184551A1 CN 2018081826 W CN2018081826 W CN 2018081826W WO 2018184551 A1 WO2018184551 A1 WO 2018184551A1
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nursing
case
care
target
payment
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PCT/CN2018/081826
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English (en)
French (fr)
Inventor
彭舜东
谢永骏
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平安科技（深圳）有限公司
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Publication of WO2018184551A1 publication Critical patent/WO2018184551A1/zh

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    • G—PHYSICS
    • G06—COMPUTING; CALCULATING OR COUNTING
    • G06Q—INFORMATION AND COMMUNICATION TECHNOLOGY [ICT] SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES; SYSTEMS OR METHODS SPECIALLY ADAPTED FOR ADMINISTRATIVE, COMMERCIAL, FINANCIAL, MANAGERIAL OR SUPERVISORY PURPOSES, NOT OTHERWISE PROVIDED FOR
    • G06Q40/00—Finance; Insurance; Tax strategies; Processing of corporate or income taxes
    • G06Q40/08—Insurance

Definitions

  • the present application relates to the field of financial services, and in particular, to a method and apparatus for paying for a pension.
  • Nursing insurance refers to insurance that provides insurance coverage for the insured's nursing expenses, which is a condition of the daily life ability disorder as stipulated in the insurance contract, and is a kind of health insurance.
  • the embodiment of the present application provides a method and device for paying for a nursing gold, which can improve the convenience of the application for nursing care and improve the claim efficiency of the nursing fund.
  • a method of payment for nursing care provided by the present application includes:
  • a target nursing case to be automatically paid out the target nursing case being a claim for a nursing policy that has completed the first care payment and the nursing responsibility is within the validity period;
  • the current system time reaches the automatic payment time of the target nursing case, the claim for the target nursing case is automatically initiated;
  • the next automatic payment time of the target nursing case is updated according to the nursing policy
  • the nursing care fund is treated by the insurance company's financial system.
  • the claim for the claim case of the nursing policy that has completed the first care payment and is still in the validity period, the claim can be automatically initiated when the automatic payment time arrives, and the applicant does not need to apply for the payment on a regular basis, thereby improving the application for nursing care. Convenience; In addition, if the target nursing case is approved after the automatic payment of the claim, the payment can be processed through the financial system, which greatly improves the claim efficiency of the nursing fund, thereby enhancing the protection function of the nursing insurance.
  • FIG. 1 is a flow chart of an embodiment of a method for paying for a nursing gold payment according to an embodiment of the present application
  • FIG. 2 is a schematic flowchart of a step 104 of a nursing gold payment method in an application scenario according to an embodiment of the present application;
  • FIG. 3 is a schematic diagram of steps of calculating a nursing gold required for the target nursing case in the present embodiment according to an embodiment of the present invention
  • FIG. 4 is a schematic flowchart of generating a claim batch by a nursing gold payment method according to an embodiment of the present application
  • FIG. 5 is a schematic flowchart of a step 403 of a nursing gold payment method in the corresponding embodiment of FIG. 4;
  • FIG. 6 is a structural diagram of a first embodiment of a care gold payment device according to an embodiment of the present application.
  • FIG. 7 is a structural diagram of a second embodiment of a nursing gold claim device according to an embodiment of the present application.
  • FIG. 8 is a structural diagram of a third embodiment of a nursing gold payment device according to an embodiment of the present application.
  • an embodiment of a nursing gold payment method in an embodiment of the present application includes:
  • the target nursing case is a claim for a nursing policy that has completed the first care payment and the nursing responsibility is within the validity period;
  • the claim case for the nursing policy that has completed the first care payment and the care responsibility is within the validity period, that is, the target nursing case automatically initiates the application for the payment of the care payment.
  • the target nursing case automatically initiates the application for the payment of the care payment.
  • the first care gold claim for the care policy can also be implemented in an automated manner.
  • the insurance company's system can interface with the medical system. When the insured is diagnosed in a hospital, the medical system sends the insured's diagnosis information to the insurance company's system. If the insurance company's system detects that the When the insurer's diagnosis information meets the claims requirements of his or her care policy, the insurance company's system can automatically initiate a caregiver claim for the insured. For the insured, such as the elderly or the family members, the insured person can be exempted from the application for claims, greatly improving the care of the insured.
  • step 102 Detect whether the current system time reaches the automatic payment time of the target nursing case, and if yes, execute step 103, and if not, continue to detect;
  • the system when the target nursing case is paid for the first time, can provide the applicant with an option for automatic payment application. If the applicant selects the option, the system automatically executes the implementation when the target nursing case is subsequently processed. The method of payment of care gold.
  • the applicant selects the option of automatic payment application, the applicant can set the automatic payment time, for example, to set the automatic payment application on the 1st of each month, and the automatic payment time of the target nursing case next month is next month. 1st.
  • the system can set a default time for the target care case as the automatic payout time.
  • the claim for the target nursing case is automatically initiated.
  • step 104 The target care case is reviewed according to a preset audit rule. If the audit fails, step 105 is performed, and if the audit is passed, step 106 is performed;
  • the target nursing case needs to be reviewed according to a preset auditing rule.
  • the audit rule can be set according to the type of the care policy corresponding to the target care case.
  • the care policy for the critical illness and the care policy for the pension can be set differently.
  • the corresponding audit rule may be obtained according to the type of the care policy corresponding to the target nursing case, and the target nursing case is reviewed and processed according to the obtained audit rule.
  • the foregoing step 104 may include:
  • Step 202 Detecting, in the nursing policy corresponding to the target nursing case, whether there are other claims in the transfer state, or whether there are other appeal cases in the nursing policy that are not completed except the target nursing case, and if so, executing Step 202, if no, step 203;
  • the above-mentioned audit rule may be set as the other claims case in the care policy corresponding to the target nursing case, and there is no such thing as the target nursing case. Other complaints that have not been completed outside. Therefore, it is determined whether there are two types of cases in the nursing policy corresponding to the target nursing case, and if so, it is determined that the target nursing case is not approved, and if not, the target nursing case is determined to pass.
  • the target nursing case is processed according to a preset process.
  • the claim for the target nursing case may be re-initiated after a certain time interval, for example, when the target nursing case is not approved, the application for the target nursing case is re-applied after 3 minutes; or The current claim for the target nursing case is cancelled, and the next automatic payment time of the target nursing case is updated according to the nursing policy, and the next automatic payment time of the target nursing case is awaited.
  • the target nursing case After the target nursing case is approved, it can be basically determined that the target nursing claim can be closed. Therefore, in order to ensure that the next claim can be automatically initiated, the next automatic maintenance of the target nursing case needs to be updated according to the nursing policy. Pay time. Specifically, if the nursing care policy stipulates that the nursing fund is paid once a month, the next automatic payment time is equal to the automatic payment time plus a natural month; if the nursing care policy stipulates that the nursing payment is paid once a quarter, then the next The automatic payout time is equal to the automatic payout time plus one quarter of the time; and so on. It can be seen that the next automatic payment time of the update is mainly determined according to the specific agreement in the corresponding nursing policy of the target nursing case.
  • the nursing care company's financial system can be used to process the nursing care payment for the target nursing case. Understandably, for most target care cases, the amount of care paid per period is the same, for example, $1,000 per period. Therefore, after the approval is passed, the financial system of the insurance company can be notified, and the financial system directly refers to the payment of the last payment of the care fund in the target nursing case.
  • the target nursing case has multiple periods of unpaid care.
  • the target nursing case completes the payment of the nursing fund for the first time
  • the payment of the nursing money after two consecutive months one monthly, two in total
  • the nursing fund of the third phase should be paid to the risk person this month. Therefore, it is necessary to calculate the nursing money required for the target nursing case this time;
  • the calculated care gold is submitted to the financial system of the insurance company such that the financial system pays the care money.
  • the step of calculating the nursing money required to be paid in the target nursing case may include:
  • the formula of the current total number of claims required may be expressed as min[(T-T0)/k, Pmax-P], where T represents the current system time, that is, the adjustment date; T0 represents the care policy agreement The occurrence date of the event, that is, the responsibility determination time.
  • T represents the current system time, that is, the adjustment date
  • T0 represents the care policy agreement
  • the occurrence date of the event that is, the responsibility determination time.
  • T0 represents the date of diagnosis of the critical illness
  • k represents the interval of the payment of the nursing care payment agreed upon by the nursing policy, if the nursing policy stipulates monthly Pay once, then k ⁇ 30.
  • (T-T0)/k can calculate the number of times the care policy is required to be paid from the time of responsibility determination to the current adjustment date.
  • Pmax represents the total number of times the care policy can be paid
  • P represents the number of times the care policy has been paid so far
  • Pmax-P represents the maximum number of payouts currently remaining for the care policy. It can be seen from the formula min[(T-T0)/k, Pmax-P] that the current total number of claims required takes a smaller value from the number of times as the current total number of claims required for the target nursing case.
  • the financial system records the nursing fund that the target nursing case corresponds to the nursing policy, and therefore, the nursing care money required for the target nursing case is the current total required nursing amount - the paid nursing money. , you can get the value of the care money that should be paid for this time.
  • the nursing money required for the current payment is calculated according to the calculation method of the above steps 301 to 303, and the calculation method is directly related to the current system time, and therefore, if the nursing policy agrees It is a monthly payment of nursing care. Even if there are multiple applications for nursing payment in the month, the system will only pay the corresponding nursing money when applying for the first payment this month, and for the remaining additional claims, even if the application is successful.
  • the final calculated value of the required care payment will also be 0, which will not cause errors or losses in the financial system, greatly improving the stability and reliability of the method.
  • the method of claiming compensation may further include:
  • step 401 it can be understood that since the current payment of the care payment can be regarded as the follow-up or supplement of the previous care payment, therefore, for the corresponding claim batch, it can also be in the last corresponding claim.
  • the modification is based on the batch. Therefore, it may be determined whether there is a claim batch corresponding to the target care case at the time of the last care payout, and if yes, executing step 402, using the last corresponding claim batch to generate the corresponding claim batch; If it does not exist, step 403 is executed, and it is necessary to rearrange and generate a claim batch corresponding to the current payment of the care payment.
  • the relevant information of the current payment of the care payment may be added, including the liability clause corresponding to the payment of the care payment and related compensation information (eg, payment)
  • the amount of money, the time of payment, etc. can generate a claim batch corresponding to the payment of the care fund in the target nursing case.
  • the information about the added benefit payment can be attached to the information of the last corresponding claim batch.
  • the embodiment when there is no claim batch of the last care payment, the embodiment re-calculates the liability clause corresponding to the previous care case payment and the related compensation information, and generates the target nursing case.
  • the nursing claim pays the corresponding claims batch.
  • the foregoing step 403 may include:
  • one target nursing case may correspond to one or more nursing policies
  • one nursing policy may correspond to one or more liability terms
  • different liability terms may correspond to different payment information.
  • each nursing policy corresponding to the target nursing case may be sequentially obtained, and each time a nursing policy is acquired, each liability clause of the nursing policy is extracted and the corresponding corresponding to the liability clause
  • the payment information is not obtained until the responsibility clause under the care policy and all relevant claims information are extracted, and then the next care policy in each of the care policies is acquired, and the above extraction steps are repeated until all the care policies are completed.
  • step 504 after all the liability clauses under the target nursing case and the corresponding related claims information are collated, the claim batch corresponding to the current nursing care claim may be generated.
  • the claim can be automatically initiated when the automatic payment time arrives, and the applicant does not need to apply for the payment on a regular basis, thereby improving the application for the nursing payment. Convenience; In addition, if the target nursing case is approved after the automatic payment of the claim, the payment can be processed through the financial system, which greatly improves the claim efficiency of the nursing fund, thereby enhancing the protection function of the nursing insurance.
  • the above mainly describes a nursing gold payment method, and a nursing gold payment device will be described in detail below.
  • FIG. 6 is a structural diagram showing a first embodiment of a care gold payment device in the embodiment of the present application.
  • a care gold payment device includes:
  • the target case determination module 601 is configured to determine a target nursing case to be automatically compensated, wherein the target nursing case is a claim case of a nursing policy that has completed the first care payment and the care responsibility is within the validity period;
  • the automatic application module 602 is configured to automatically initiate a claim for the target nursing case if the current system time reaches the automatic payment time of the target nursing case;
  • the case review module 603 is configured to review the target nursing case according to a preset review rule
  • the payout time update module 604 is configured to: if the target care case is approved, update the next automatic payout time of the target care case according to the care policy;
  • the case claim module 605 is configured to perform a care payment process on the target nursing case through the financial system of the insurance company.
  • FIG. 7 is a structural diagram showing a second embodiment of a nursing gold claiming device in the embodiment of the present application.
  • the case claim module 605 can include:
  • the current total number determining sub-unit 6051 is configured to determine a current required total number of claims for the target nursing case according to the current system time and the responsibility determination time of the nursing policy;
  • the current total care gold unit 6052 is configured to calculate a current required total nursing amount of the target nursing case according to the current required total number of claims and a single-care amount pre-agreed by the nursing policy;
  • the present nursing gold calculation sub-unit 6053 is configured to calculate a difference between the current required total nursing care and the nursing care premium that has been paid by the nursing policy, and obtain the nursing money required for the target nursing case to be paid this time.
  • the submitting unit 6054 is configured to submit the calculated nursing fund to the financial system of the insurance company, so that the financial system pays the nursing fund.
  • case review module 603 can include:
  • the case detecting unit 6031 is configured to detect whether there is another claim case in the transfer policy corresponding to the target nursing case, or whether there are other appeal cases that are not completed except the target nursing case in the nursing policy ;
  • the audit failing unit 6032 is configured to: if the detection result of the case detecting unit 6031 is YES, determine that the target nursing case review fails;
  • the auditing pass unit 6033 is configured to determine that the target nursing case is approved if the detection result of the case detecting unit 6031 is negative.
  • FIG. 8 is a structural diagram showing a third embodiment of a care gold payment device in the embodiment of the present application.
  • the care gold payment device may further include:
  • the determining module 606 is configured to determine, after the approval of the target nursing case, whether there is a claim batch corresponding to the target nursing case at the time of the last nursing payment;
  • the first batch generation module 607 is configured to: if the judgment result of the determination module 606 is YES, add the target nursing case to the current care based on the corresponding claims batch at the time of the last care payment The liability clause corresponding to the gold payment and the related compensation information, and generate a claim batch corresponding to the payment of the nursing care claim in the target nursing case;
  • the second batch generating module 608 is configured to: if the determining result of the determining module 606 is negative, re-calculating the liability clause corresponding to the nursing care claim of the target nursing case and related compensation information, and generating the target nursing case This nursing gold payment corresponds to the claim batch.
  • the second batch generation module 608 can include:
  • the nursing policy obtaining unit 6081 is configured to acquire each nursing policy corresponding to the target nursing case
  • the liability clause obtaining unit 6082 is configured to acquire respective liability clauses corresponding to each nursing policy in the respective nursing policies;
  • the claim information sorting unit 6083 is configured to sort the related claims information corresponding to the respective liability clauses according to the previous care gold claims record of the target nursing case;
  • the batch generating unit 6084 is configured to generate a claim batch corresponding to the current nursing care claim in the target nursing case according to the respective liability terms under the respective nursing policies and the corresponding related claims information.

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Abstract

本申请实施例公开了一种护理金赔付方法，用于解决现有护理金申请较为繁琐、不便利的问题。本申请实施例方法包括：确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；根据预设的审核规则对所述目标护理案件进行审核；若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。本申请实施例还提供一种护理金赔付装置。

Description

一种护理金赔付方法和装置
本申请申明享有2017年04月07日递交的申请号为201710225202.X、名称为“一种空调的控制方法及空调”中国专利申请的优先权，该中国专利申请的整体内容以参考的方式结合在本申请中。
技术领域
本申请涉及金融服务领域，尤其涉及一种护理金赔付方法和装置。
 背景技术
护理保险，是指以因保险合同约定的日常生活能力障碍引发护理需要为给付保险金条件，为被保险人的护理支出提供保障的保险，是健康保险的一种。
目前，在针对护理保险进行护理金理赔时，需要申请人定期（如：每月）进行赔付申请，导致护理金申请较为繁琐，尤其是对于存在能力障碍的申请人来说，往往由于未准时发起赔付申请而导致错过申请时限，使得护理保险未起到该有的保障作用。
 技术问题
本申请实施例提供了一种护理金赔付方法和装置，能够提高护理金申请的便利性，并且提高护理金的理赔效率。
 技术解决方案
本申请提供的一种护理金赔付方法，包括：
确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；
根据预设的审核规则对所述目标护理案件进行审核；
若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
 有益效果
本申请实施例中对于已完成首次护理金赔付且仍在有效期内的护理保单的理赔案件，可以在自动赔付时间到达时自动发起赔付申请，无需申请人定期去进行赔付申请，提高了护理金申请的便利性；另外，自动发起赔付申请后若目标护理案件审核通过，即可通过财务系统进行护理金给付处理，大大提高了护理金的理赔效率，从而提升了护理保险起到的保障作用。
 附图说明
图1为本申请实施例中一种护理金赔付方法一个实施例流程图；
图2为本申请实施例中一种护理金赔付方法步骤104在一个应用场景下的流程示意图；
图3为本申请实施例中一种护理金赔付方法计算所述目标护理案件本次所需赔付的护理金的步骤示意图；
图4为本申请实施例中一种护理金赔付方法生成理赔批单的流程示意图；
图5为图4对应实施例中一种护理金赔付方法步骤403的流程示意图；
图6为本申请实施例中一种护理金赔付装置第一个实施例结构图；
图7为本申请实施例中一种护理金赔付装置第二个实施例结构图；
图8为本申请实施例中一种护理金赔付装置第三个实施例结构图。
 本发明的实施方式
请参阅图1，本申请实施例中一种护理金赔付方法一个实施例包括：
101、确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
本实施例中，主要为那些已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件，即所述目标护理案件来自动发起护理金赔付申请。可以理解的是，考虑到护理保险的性质，当被保险人发生护理保单上约定的事件时，例如重疾确诊后，申请人需要对所述护理保单提出首次护理金赔付请求，并提交相关的理赔材料完成首次护理金赔付请求。在完成首次赔付之后，由于护理保险一般是分期进行赔付的，例如每月赔付一次，相对现有技术中申请人需要每月主动进行一次申请操作才能得到当月赔付的护理金，本实施例中可以自动为申请人进行该目标护理案件的赔付申请，从而提高了护理金申请的便利性。
特别地，在实际应用中，护理保单的首次护理金赔付请求也可以通过自动的方式实现。例如，保险公司的系统可以与医疗系统进行数据对接，当被保险人在某医院确诊后，医疗系统将该被保险人的确诊信息发送至保险公司的系统，保险公司的系统若检测发现该被保险人的确诊信息满足其护理保单的理赔要求时，保险公司的系统即可自动为该被保险人发起护理金赔付申请。这对于诸如独孤老人、无家属病人等被保险人来说，可以免除其申请理赔之苦，大大提高了被保险人的护理保障。
102、检测当前系统时间是否到达所述目标护理案件的自动赔付时间，若是，则执行步骤103，若否，则继续检测；
本实施例中，目标护理案件在首次进行护理金赔付时，系统可以为申请人提供自动赔付申请的选项，若申请人选取了该选项，则系统在后续处理该目标护理案件时自动执行本实施例的护理金赔付方法。在申请人选取自动赔付申请的选项时，申请人可以自行设定自动赔付时间，例如设定为每月1日进行自动赔付申请，则该目标护理案件下个月的自动赔付时间为下个月1日。特别地，若申请人没有设定具体的自动赔付时间，系统可以为该目标护理案件设定一个默认时间作为该自动赔付时间。
103、自动发起所述目标护理案件的赔付申请；
本实施例中，若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请。
104、根据预设的审核规则对所述目标护理案件进行审核，若审核不通过，则执行步骤105，若审核通过，则执行步骤106；
本实施例中，为了避免本次赔付申请的处理与该目标护理案件的其它处理流程发生冲突或混淆，需要根据预设的审核规则对所述目标护理案件进行审核。可以理解的是，该审核规则可以根据该目标护理案件对应的护理保单的类型进行设定，例如针对重疾的护理保单与针对养老的护理保单可以分别设定不同的审核规则。在审核之前，可以先根据该目标护理案件对应的护理保单的类型获取到对应的审核规则，在根据获取到的审核规则对该目标护理案件进行审核处理。
进一步地，如图2所示，上述步骤104可以包括：
201、检测所述目标护理案件对应的护理保单中是否存在处于转账状态的其它理赔案件，或者所述护理保单中是否存在除所述目标护理案件之外未完成的其它申诉案件，若是，则执行步骤202，若均为否，则执行步骤203；
202、确定所述目标护理案件审核不通过；
203、确定所述目标护理案件审核通过。
对于上述步骤201~203，在一个应用场景中，上述的审核规则可以设定为该目标护理案件对应的护理保单中不能存在处于转账状态的其它理赔案件，以及不能存在除所述目标护理案件之外未完成的其它申诉案件。因此，检测该目标护理案件对应的护理保单中是否存在这两类案件，若是，则确定该目标护理案件审核不通过，若均为否，才确定该目标护理案件审核通过。
105、按照预设流程对所述目标护理案件进行处理；
本实施例中，当所述目标护理案件审核不通过时，则按照预设流程对所述目标护理案件进行处理。具体地，可以在一定时间间隔之后再次发起该目标护理案件的赔付申请，例如，在目标护理案件审核不通过时，设定3分钟之后再次尝试对该目标护理案件进行赔付申请；或者，也可以将该目标护理案件本次的赔付申请取消，并据所述护理保单更新所述目标护理案件下一次的自动赔付时间，等待到达该目标护理案件下一次的自动赔付时间。
106、根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
在目标护理案件审核通过之后，基本可以确定该目标护理案件本次赔付申请可以结案，因此，为了保证下一次赔付申请可以自动发起，需要根据所述护理保单更新所述目标护理案件下一次的自动赔付时间。具体地，若该护理保单中约定护理金每月赔付一次，则下一次的自动赔付时间等于本次自动赔付时间加上一个自然月；若该护理保单中约定护理金每季度赔付一次，则下一次的自动赔付时间等于本次自动赔付时间加上一个季度的时间；等等。可见，更新的下一次的自动赔付时间主要根据目标护理案件对应护理保单中的具体约定而定。
107、通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
在目标护理案件审核通过之后，可以通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。可以理解的是，对于大部分目标护理案件来说，其每期给付的护理金是相同的，例如每期给付1000元。因此，在审核通过之后，即可通知保险公司的财务系统，财务系统直接参照该目标护理案件上一次给付的护理金进行给付即可。
特别地，由于部分原因，例如上一次赔付申请失败、上一次赔付申请审核不通过或者上一次未成功发起赔付申请等等，有可能导致该目标护理案件存在多期未给付护理金的情况。例如，该目标护理案件首次完成护理金赔付之后，由于出险人账户变动的问题，导致之后连续两个月（每月1期，共2期）的护理金均给付失败。此时，当第三个月进行护理金给付时，本月理应将将3期的护理金一同给付至出险人，因此需要计算所述目标护理案件本次所需赔付的护理金；然后，将计算得到的所述护理金提交至保险公司的财务系统，使得所述财务系统给付所述护理金。
具体地，如图3所示，计算所述目标护理案件本次所需赔付的护理金的步骤具体可以包括：
301、根据所述当前系统时间和所述护理保单的责任确定时间确定所述目标护理案件的当前所需总赔付次数；
302、根据所述当前所需总赔付次数和所述护理保单预先约定的单次护理金计算所述目标护理案件的当前所需总护理金；
303、计算所述当前所需总护理金与所述护理保单已赔付的护理金之差，得到所述目标护理案件本次所需赔付的护理金。
对于上述步骤301，当前所需总赔付次数的公式可以表示为min[(T-T0)/k，Pmax-P]，其中，T表示当前系统时间，也即理算日；T0表示护理保单约定的事件的发生日，即责任确定时间，例如，若护理保单约定的是重疾，则T0表示重疾确诊日；k表示护理保单约定的护理金赔付的分期间隔，若该护理保单约定每月赔付一次，则k≈30。从而，(T-T0)/k可以计算得到该护理保单从责任确定时间到当前理算日为止一共所需赔付的次数。另外，Pmax表示护理保单可以赔付的总次数，P表示该护理保单目前为止已赔付的次数，因此Pmax-P表示该护理保单当前剩余的最大赔付次数。由公式min[(T-T0)/k，Pmax-P]可知，当前所需总赔付次数从两者的次数中取较小的值作为所述目标护理案件的当前所需总赔付次数。
对于步骤302，本实施例中，护理保单预先约定的每次护理金均相等，因此，所述目标护理案件的当前所需总护理金=当前所需总赔付次数*单次护理金。
对于步骤303，财务系统中记录有该目标护理案件对应护理保单已赔付的护理金，因此，所述目标护理案件本次所需赔付的护理金=当前所需总护理金-已赔付的护理金，即可得到本次理应赔付的护理金的值。可以理解的是，由于本实施例中，本次所需赔付的护理金是根据上述步骤301~303的计算方法计算得到的，该计算方法与当前系统时间直接关联，因此，假如护理保单约定的是每月赔付一次护理金，即便在当月进行了多次护理金赔付申请，本系统只会在本月第一次赔付申请时给付相应的护理金，而对于其余额外的赔付申请，即便申请成功，最后计算得到的本次所需赔付的护理金的值也会为0，从而不会造成财务系统的出错或损失，大大提高了本方法的稳定性和可靠性。
进一步地，本实施例中，由于每次给付护理金之后，保险公司均需要给出相应的批单提供给申请人或者出险人，因此，为了提高护理金赔付时批单的生成效率，如图4所示，所述护理金赔付方法还可以包括：
401、在所述目标护理案件审核通过之后，判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，若是，则执行步骤402，若否，则执行步骤403；
402、在所述上一次护理金赔付时对应的理赔批单的基础上，添加所述目标护理案件本次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单；
403、重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。
对于步骤401，可以理解的是，由于本次护理金赔付可以看做上一次护理金赔付的后续或者补充，因此，对于本次对应的理赔批单而言，其也可以在上一次对应的理赔批单的基础上进行修改得到。从而，可以先判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，若存在，则执行步骤402，利用上一次对应的理赔批单生成本次对应的理赔批单；若不存在，则执行步骤403，需要重新整理并生成本次护理金赔付对应的理赔批单。
对于步骤402，在上一次护理金赔付时对应的理赔批单的基础上，可以添加上本次护理金赔付的相关信息，包括本次护理金赔付对应的责任条款以及相关赔付信息（如：赔付金额、赔付时间等），即可生成所述目标护理案件本次护理金赔付对应的理赔批单。一般来说，添加的本次护理金赔付的相关信息可以附加在上一次对应的理赔批单的信息后面。
对于步骤403，当不存在上一次护理金赔付的理赔批单时，本实施例重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。具体地，如图5所示，上述步骤403可以包括：
501、获取所述目标护理案件对应的各个护理保单；
502、获取所述各个护理保单中每个护理保单对应的各个责任条款；
503、根据所述目标护理案件的历次护理金赔付记录整理所述各个责任条款对应相关赔付信息；
504、根据整理得到的所述各个护理保单下的所述各个责任条款以及对应的相关赔付信息生成所述目标护理案件本次护理金赔付对应的理赔批单。
对于上述步骤501~504，本实施例中，一个目标护理案件可以对应一个或多个护理保单，而一个护理保单上可以对应一个或多个责任条款，不同的责任条款则可以对应不同的赔付信息。从而，为了生成完整且有层次的理赔批单，可以依次获取该目标护理案件对应的各个护理保单，每获取到一个护理保单之后，则提取该护理保单的各个责任条款以及这些责任条款对应的相关赔付信息，直到该护理保单下的责任条款以及所有相关赔付信息均提取完成后，再获取所述各个护理保单中的下一个护理保单，重复上述提取步骤，直到所有护理保单均完成提取为止。
对于步骤504，当整理出该目标护理案件下的所有责任条款以及对应的相关赔付信息之后，即可生成所述目标护理案件本次护理金赔付对应的理赔批单。
本实施例中对于已完成首次护理金赔付且仍在有效期内的护理保单的理赔案件，可以在自动赔付时间到达时自动发起赔付申请，无需申请人定期去进行赔付申请，提高了护理金申请的便利性；另外，自动发起赔付申请后若目标护理案件审核通过，即可通过财务系统进行护理金给付处理，大大提高了护理金的理赔效率，从而提升了护理保险起到的保障作用。
上面主要描述了一种护理金赔付方法，下面将对一种护理金赔付装置进行详细描述。
图6示出了本申请实施例中一种护理金赔付装置第一个实施例结构图。
本实施例中，一种护理金赔付装置包括：
目标案件确定模块601，用于确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
自动申请模块602，用于若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；
案件审核模块603，用于根据预设的审核规则对所述目标护理案件进行审核；
赔付时间更新模块604，用于若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
案件赔付模块605，用于通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
图7示出了本申请实施例中一种护理金赔付装置第二个实施例结构图。
如图7所示，进一步地，所述案件赔付模块605可以包括：
当前总次数确定子单元6051，用于根据所述当前系统时间和所述护理保单的责任确定时间确定所述目标护理案件的当前所需总赔付次数；
当前总护理金子单元6052，用于根据所述当前所需总赔付次数和所述护理保单预先约定的单次护理金计算所述目标护理案件的当前所需总护理金；
本次护理金计算子单元6053，用于计算所述当前所需总护理金与所述护理保单已赔付的护理金之差，得到所述目标护理案件本次所需赔付的护理金。
提交单元6054，用于将计算得到的所述护理金提交至保险公司的财务系统，使得所述财务系统给付所述护理金。
进一步地，所述案件审核模块603可以包括：
案件检测单元6031，用于检测所述目标护理案件对应的护理保单中是否存在处于转账状态的其它理赔案件，或者所述护理保单中是否存在除所述目标护理案件之外未完成的其它申诉案件；
审核不通过单元6032，用于若所述案件检测单元6031的检测结果为是，则确定所述目标护理案件审核不通过；
审核通过单元6033，用于若所述案件检测单元6031的检测结果均为否，则确定所述目标护理案件审核通过。
图8示出了本申请实施例中一种护理金赔付装置第三个实施例结构图。
如图8所示，进一步地，所述护理金赔付装置还可以包括：
判断模块606，用于在所述目标护理案件审核通过之后，判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单；
第一批单生成模块607，用于若所述判断模块606的判断结果为是，则在所述上一次护理金赔付时对应的理赔批单的基础上，添加所述目标护理案件本次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单；
第二批单生成模块608，用于若所述判断模块606的判断结果为否，则重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。
进一步地，所述第二批单生成模块608可以包括：
护理保单获取单元6081，用于获取所述目标护理案件对应的各个护理保单；
责任条款获取单元6082，用于获取所述各个护理保单中每个护理保单对应的各个责任条款；
赔付信息整理单元6083，用于根据所述目标护理案件的历次护理金赔付记录整理所述各个责任条款对应相关赔付信息；
批单生成单元6084，用于根据整理得到的所述各个护理保单下的所述各个责任条款以及对应的相关赔付信息生成所述目标护理案件本次护理金赔付对应的理赔批单。
以上所述实施例仅用以说明本申请的技术方案，而非对其限制；尽管参照前述实施例对本申请进行了详细的说明，本领域的普通技术人员应当理解：其依然可以对前述各实施例所记载的技术方案进行修改，或者对其中部分技术特征进行等同替换；而这些修改或者替换，并不使相应技术方案的本质脱离本申请各实施例技术方案的精神和范围，均应包含在本申请的保护范围之内。

Claims (20)

  1. 一种护理金赔付方法，其特征在于，包括：
    确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
    若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；
    根据预设的审核规则对所述目标护理案件进行审核；
    若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
    通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
  2. 根据权利要求1所述的护理金赔付方法，其特征在于，所述通过保险公司的财务系统对所述目标护理案件进行护理金给付处理包括：
    根据所述当前系统时间和所述护理保单的责任确定时间确定所述目标护理案件的当前所需总赔付次数；
    根据所述当前所需总赔付次数和所述护理保单预先约定的单次护理金计算所述目标护理案件的当前所需总护理金；
    计算所述当前所需总护理金与所述护理保单已赔付的护理金之差，得到所述目标护理案件本次所需赔付的护理金；
    将计算得到的所述护理金提交至保险公司的财务系统，使得所述财务系统给付所述护理金。
  3. 根据权利要求1所述的护理金赔付方法，其特征在于，所述根据预设的审核规则对所述目标护理案件进行审核包括：
    检测所述目标护理案件对应的护理保单中是否存在处于转账状态的其它理赔案件，或者所述护理保单中是否存在除所述目标护理案件之外未完成的其它申诉案件；
    若所述目标护理案件对应的护理保单中存在处于转账状态的其它理赔案件，或者所述护理保单中存在除所述目标护理案件之外未完成的其它申诉案件，则确定所述目标护理案件审核不通过；
    若所述目标护理案件对应的护理保单中不存在处于转账状态的其它理赔案件，或者所述护理保单中不存在除所述目标护理案件之外未完成的其它申诉案件，则确定所述目标护理案件审核通过。
  4. 根据权利要求1至3中任一项所述的护理金赔付方法，其特征在于，所述护理金赔付方法还包括：
    在所述目标护理案件审核通过之后，判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单；
    若存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，则在所述上一次护理金赔付时对应的理赔批单的基础上，添加所述目标护理案件本次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单；
    若不存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，则重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。
  5. 根据权利要求4所述的护理金赔付方法，其特征在于，所述重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单包括：
    获取所述目标护理案件对应的各个护理保单；
    获取所述各个护理保单中每个护理保单对应的各个责任条款；
    根据所述目标护理案件的历次护理金赔付记录整理所述各个责任条款对应相关赔付信息；
    根据整理得到的所述各个护理保单下的所述各个责任条款以及对应的相关赔付信息生成所述目标护理案件本次护理金赔付对应的理赔批单。
  6. 一种护理金赔付装置，其特征在于，包括：
    目标案件确定模块，用于确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
    自动申请模块，用于若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；
    案件审核模块，用于根据预设的审核规则对所述目标护理案件进行审核；
    赔付时间更新模块，用于若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
    案件赔付模块，用于通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
  7. 根据权利要求6所述的护理金赔付装置，其特征在于，所述案件赔付模块包括：
    当前总次数确定单元，用于根据所述当前系统时间和所述护理保单的责任确定时间确定所述目标护理案件的当前所需总赔付次数；
    当前总护理金单元，用于根据所述当前所需总赔付次数和所述护理保单预先约定的单次护理金计算所述目标护理案件的当前所需总护理金；
    本次护理金计算单元，用于计算所述当前所需总护理金与所述护理保单已赔付的护理金之差，得到所述目标护理案件本次所需赔付的护理金；
    提交单元，用于将计算得到的所述护理金提交至保险公司的财务系统，使得所述财务系统给付所述护理金。
  8. 根据权利要求6所述的护理金赔付装置，其特征在于，所述案件审核模块包括：
    案件检测单元，用于检测所述目标护理案件对应的护理保单中是否存在处于转账状态的其它理赔案件，或者所述护理保单中是否存在除所述目标护理案件之外未完成的其它申诉案件；
    审核不通过单元，用于若所述案件检测单元的检测结果为是，则确定所述目标护理案件审核不通过；
    审核通过单元，用于若所述案件检测单元的检测结果均为否，则确定所述目标护理案件审核通过。
  9. 根据权利要求6至8中任一项所述的护理金赔付装置，其特征在于，所述护理金赔付装置还包括：
    判断模块，用于在所述目标护理案件审核通过之后，判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单；
    第一批单生成模块，用于若所述判断模块的判断结果为是，则在所述上一次护理金赔付时对应的理赔批单的基础上，添加所述目标护理案件本次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单；
    第二批单生成模块，用于若所述判断模块的判断结果为否，则重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。
  10. 根据权利要求9所述的护理金赔付装置，其特征在于，所述第二批单生成模块包括：
    护理保单获取单元，用于获取所述目标护理案件对应的各个护理保单；
    责任条款获取单元，用于获取所述各个护理保单中每个护理保单对应的各个责任条款；
    赔付信息整理单元，用于根据所述目标护理案件的历次护理金赔付记录整理所述各个责任条款对应相关赔付信息；
    批单生成单元，用于根据整理得到的所述各个护理保单下的所述各个责任条款以及对应的相关赔付信息生成所述目标护理案件本次护理金赔付对应的理赔批单。
  11. 一种护理金赔付装置，包括存储器、处理器以及存储在所述存储器中并可在所述处理器上运行的计算机可读指令，其特征在于，所述处理器执行所述计算机可读指令时实现如下步骤：
    确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
    若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；
    根据预设的审核规则对所述目标护理案件进行审核；
    若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
    通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
  12. 根据权利要求11所述的护理金赔付装置，其特征在于，所述通过保险公司的财务系统对所述目标护理案件进行护理金给付处理包括：
    根据所述当前系统时间和所述护理保单的责任确定时间确定所述目标护理案件的当前所需总赔付次数；
    根据所述当前所需总赔付次数和所述护理保单预先约定的单次护理金计算所述目标护理案件的当前所需总护理金；
    计算所述当前所需总护理金与所述护理保单已赔付的护理金之差，得到所述目标护理案件本次所需赔付的护理金；
    将计算得到的所述护理金提交至保险公司的财务系统，使得所述财务系统给付所述护理金。
  13. 根据权利要求11所述的护理金赔付装置，其特征在于，所述根据预设的审核规则对所述目标护理案件进行审核包括：
    检测所述目标护理案件对应的护理保单中是否存在处于转账状态的其它理赔案件，或者所述护理保单中是否存在除所述目标护理案件之外未完成的其它申诉案件；
    若所述目标护理案件对应的护理保单中存在处于转账状态的其它理赔案件，或者所述护理保单中存在除所述目标护理案件之外未完成的其它申诉案件，则确定所述目标护理案件审核不通过；
    若所述目标护理案件对应的护理保单中不存在处于转账状态的其它理赔案件，或者所述护理保单中不存在除所述目标护理案件之外未完成的其它申诉案件，则确定所述目标护理案件审核通过。
  14. 根据权利要求11-13任一项所述的护理金赔付装置，其特征在于，所述处理器执行所述计算机可读指令时还实现如下步骤：
    在所述目标护理案件审核通过之后，判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单；
    若存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，则在所述上一次护理金赔付时对应的理赔批单的基础上，添加所述目标护理案件本次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单；
    若不存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，则重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。
  15. 根据权利要求14所述的护理金赔付装置，其特征在于，所述重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单包括：
    获取所述目标护理案件对应的各个护理保单；
    获取所述各个护理保单中每个护理保单对应的各个责任条款；
    根据所述目标护理案件的历次护理金赔付记录整理所述各个责任条款对应相关赔付信息；
    根据整理得到的所述各个护理保单下的所述各个责任条款以及对应的相关赔付信息生成所述目标护理案件本次护理金赔付对应的理赔批单。
  16. 一种计算机可读存储介质，所述计算机可读存储介质存储有计算机可读指令，其特征在于，所述计算机可读指令被处理器执行时实现如下步骤：
    确定待自动赔付的目标护理案件，所述目标护理案件为已完成首次护理金赔付、且护理责任处于有效期内的护理保单的理赔案件；
    若当前系统时间到达所述目标护理案件的自动赔付时间，则自动发起所述目标护理案件的赔付申请；
    根据预设的审核规则对所述目标护理案件进行审核；
    若所述目标护理案件审核通过，则根据所述护理保单更新所述目标护理案件下一次的自动赔付时间；
    通过保险公司的财务系统对所述目标护理案件进行护理金给付处理。
  17. 根据权利要求16所述的计算机可读存储介质，其特征在于，所述通过保险公司的财务系统对所述目标护理案件进行护理金给付处理包括：
    根据所述当前系统时间和所述护理保单的责任确定时间确定所述目标护理案件的当前所需总赔付次数；
    根据所述当前所需总赔付次数和所述护理保单预先约定的单次护理金计算所述目标护理案件的当前所需总护理金；
    计算所述当前所需总护理金与所述护理保单已赔付的护理金之差，得到所述目标护理案件本次所需赔付的护理金；
    将计算得到的所述护理金提交至保险公司的财务系统，使得所述财务系统给付所述护理金。
  18. 根据权利要求16所述的计算机可读存储介质，其特征在于，所述根据预设的审核规则对所述目标护理案件进行审核包括：
    检测所述目标护理案件对应的护理保单中是否存在处于转账状态的其它理赔案件，或者所述护理保单中是否存在除所述目标护理案件之外未完成的其它申诉案件；
    若所述目标护理案件对应的护理保单中存在处于转账状态的其它理赔案件，或者所述护理保单中存在除所述目标护理案件之外未完成的其它申诉案件，则确定所述目标护理案件审核不通过；
    若所述目标护理案件对应的护理保单中不存在处于转账状态的其它理赔案件，或者所述护理保单中不存在除所述目标护理案件之外未完成的其它申诉案件，则确定所述目标护理案件审核通过。
  19. 根据权利要求16-18任一项所述的计算机可读存储介质，其特征在于，所述计算机可读指令被处理器执行时还实现如下步骤：
    在所述目标护理案件审核通过之后，判断是否存在所述目标护理案件在上一次护理金赔付时对应的理赔批单；
    若存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，则在所述上一次护理金赔付时对应的理赔批单的基础上，添加所述目标护理案件本次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单；
    若不存在所述目标护理案件在上一次护理金赔付时对应的理赔批单，则重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单。
  20. 根据权利要求16-19任一项所述的计算机可读存储介质，其特征在于，所述重新理算所述目标护理案件历次护理金赔付对应的责任条款以及相关赔付信息，生成所述目标护理案件本次护理金赔付对应的理赔批单包括：
    获取所述目标护理案件对应的各个护理保单；
    获取所述各个护理保单中每个护理保单对应的各个责任条款；
    根据所述目标护理案件的历次护理金赔付记录整理所述各个责任条款对应相关赔付信息；
    根据整理得到的所述各个护理保单下的所述各个责任条款以及对应的相关赔付信息生成所述目标护理案件本次护理金赔付对应的理赔批单。
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