第5讲 健康保险.pdfVIP

第5讲 健康保险 《人寿与健康保险》课程参考讲义 2014年秋季 1 Outline 1 Introduction 2 Medical Expense Insurance 医疗费用保险 3 Disease Payment Insurance 疾病给付保险 4 Long-Term Care Insurance 长期护理保险 5 Disability Income Insurance 失能收入保险 6 China’s Regulation on Health Insurance 2 1 Introduction 1.1 含义 1.2 种类 3 1.1 含义  Health Insurance: any form of insurance whose payment is contingent on the insured incurring additional expenses or losing income because of incapacity or loss of good health.  It is sometimes called accident and health insurance, accident and sickness insurance, or disability insurance. 4 1.1 含义  Health insurance contracts are more complex than life insurance contracts. Why?  2011 年商业健康险总保费占人身险保费7% 。美国数据 36%。 5 1.2 中国 《健康保险管理办法》的分类  本办法所称健康保险，是指保险公司通过疾病保险、医疗保险、 失能收入损失保险和护理保险等方式对因健康原因导致的损失 给付保险金的保险。  本办法所称疾病保险，是指以保险合同约定的疾病的发生为 给付保险金条件的保险。  本办法所称医疗保险，是指以保险合同约定的医疗行为的发 生为给付保险金条件，为被保险人接受诊疗期间的医疗费用 支出提供保障的保险。  本办法所称失能收入损失保险，是指以因保险合同约定的疾 病或者意外伤害导致工作能力丧失为给付保险金条件，为被 保险人在一定时期内收入减少或者中断提供保障的保险。  本办法所称护理保险，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。 6 2 Medical Expense Insurance 医疗费用保险 2.1 含义 2.2 主要内容 2.3 主要类型 2.4 续保条款 7 2.1 Medical expense insurance  Plans may be limited to basic benefits for specific kinds of medical services or may provide comprehensive benefits for all major medical expenses associated with severe injury or long-term illness.  Benefits may be paid directly to the health care provider or institution or as reimbursement of actual expenses incurred.  Some benefits are paid as fixed amounts without regard to the actual costs of care. 8 2.1 Medical expense insurance  Who need individual health insurance?