健康保険引受プロセス

The insurance industry functions by moving the risk of expensive, catastrophic events from individuals, who cannot afford to bear the risk, to the capital markets, which can. The insurance company takes in premiums from customers and works hard to predict its future expenditures, attempting to set premiums, plus whatever the company can earn from its own investment portfolio, above expenditures.

1. データ収集

   • 引受プロセスの最初のステップは、詳細な保険数理データの収集です。 Insurance companies analyze data from government sources such as the Centers for Disease Control, National Institute of Health and the Occupational Safety and Health Administration, from private sources such as the American Heart Association and the American Cancer Association, and their own internal data and claims experience. They attempt to predict, based on past experience, the frequency and severity of illnesses and injuries within their market, and estimate the cost of treatment.

   フィールド引受

   • 保険代理店は、保険業界の主要なフィールドアンダーライターです。保険代理店は頻繁に将来の顧客に直接会います。 While the agent is usually selling on a commission basis, he is also expected to use independent judgment and not take applications from people with obvious and severe health problems that would normally disqualify them.

   アプリケーション

   • 顧客は、1つ以上の航空会社を使用して、保険の1つ以上の申請書に記入します。各キャリアには、健康と歴史に関連する質問のリストがあります。エージェントは単語を一言で尋ね、申請者の回答を正確に記録する必要があります。この時点で、一部の申請者は完全に上映される場合があります。 For example, it is common for insurance carriers to automatically deny coverage for individuals who have undergone treatment for cancer or other severe illnesses within the last three years. Those with clean medical histories, or who fall into "gray areas," have their applications forwarded to the insurance company underwriting staff.

   医療記録チェック

   • Life and health insurance companies routinely pull medical history information from the Medical Information Bureau, a national database of health information, set up to prevent insurance fraud.保険会社からの資料情報を源泉徴収しながら、保険に応募する消費者の能力に対するチェックとして機能します。場合によっては、保険会社は、引受決定を行う前に、参加者から追加の記録を要求することができます。

   承認または不承認

   • Once all MIB information and attending physician information is received, the insurance company may contact the agent or applicant for additional information. Otherwise, the insurance company will approve the applicant as a preferred risk, or assign a lower-risk category for the customer, which typically involves a higher premium, to compensate the insurance company for the risk. 1つ以上のリスク要因が会社に受け入れられない場合、当社は申請を拒否し、受け取った保険料を払い戻します。