國內保險經營，長久以來即是人身保險及財產保險分業經營方式，但兩者的經營規模差距很大，據統計資料顯示，壽險業這五年來的傷害險保費收入，平均每年約有580億元，健康險平均年約1260億元，對於產險業整體業界總保費收入約1100億元的市場規模而言，實在是塊誘人和商機無限的新市場，能加入傷害險或健康險的經營，將是產險業者突破經營瓶頸的關鍵，不僅保險市場會產生蛻變，更會對消費大眾帶來多元的選擇與影響。
在此背景下，本研究主要探討產險業經營傷害險的績效，並舉個案實例經營此單一險種的過程，就其在商品研發、行銷、核保和理賠等各項作業流程，進行探討分析。經本研究個案分析，歸納出幾點問題，一是在經營策略面，以業績成長為首要的考量，自然會選擇通路商的行銷方式，所謂「掌握通路，就是贏家」，兩年來通路業績佔了該險種的73%，而其賠款金額佔率，亦佔了76%左右，經營績效的結果顯示出「成也通路，敗也通路」，如何強化通路商之管理是經營重點。二是由理賠資料分析統計，並與壽險業資料比較，發現有相關性趨勢，但卻有相對惡化的現象，諸如平均死亡率，男性比女性多出5倍以上，比壽險業的3倍高；平均每件死亡賠款230萬元，比壽險業的120萬元，高出近一倍，且又以男性50~59歲的年齡層最高，此點顯示出其商品是否有「保費太低而保障過高」的問題。三是其面臨人力和經驗不足的問題，加上缺乏醫療、法務、徵信調查等相關專業人員及其運作經驗，無法在核保和理賠作業時，因應實際的作業需求。
我國保險法經過兩次修正後，現在已開放產險業者得以經營傷害險，再者，有關健康險是否可進一步開放予產險業者經營，相信很快會經立法院通過修法審議。故本研究的結果，即是找出經營問題和原因，並提出改善建議，期能提供產險業者經營傷害險或未來健康險的參酌。
關鍵字：個人傷害保險、綜合率、非比率再保險 / In our insurance market, there are two types of operation, that is, life insurance and non-life insurance, but the business scale of the two types has a long way to go. According to the data, the average premium income of whole life insurance market of the personal accident and health insurance is about NT$58 billion and NT$126 billion per year respectively among these five years. Relative to the non-life insurance which premium income is about NT$110 billion, it’s really a captivating and unlimited new market that the non-life insurance can take the risk about the personal accident and health insurance. From my point of view, it will be the main key to break through the bottleneck of operation of the non-life insurance market. Not only the whole insurance market will be changed but also it can bring multi-choice and influence to consumers.
Under this background, the main task of this research is discussing the non-life insurance’s result of operation the personal accident insurance. It has a real case that also includes the product of development, marketing, underwriter and claim for further discussion and analysis. According to the research of this case, it can generalize some points as below. The first is about the tactic of operation: we will choice the way of marketing way of channel if we consider the growth of premium income as primary issue. What is called” Someone will be a winner if he controls the channel”. In our company, the business of channel was occupied about 73% of the personal accident insurance and the claim also in the same situation was about 76% over the past two years. Unfortunately, the result of operation is “Control the channel will make someone success and failure”, so the key point of operation is how to enhance the management of channel. The second is about the statistics of claim: we compared with the data of life and non-life insurance and find some related trends, but there is a phenomenon of related aggravation, such as rate of average death, men are five times more than women in non-life insurance but only three times in life
insurance statistics; the average indemnity of death is about NT$2.3 million in non-life insurance which is one time higher than life insurance market and especially with men that age level among in 50~59 years old. On the basis of above mentioned, it shows the problem of this product have higher indemnification but lower premium income. The third is about the problem of lack of manpower and inadequate experience, in addition, it also lack such relevant professional personnel as medical, legal and investigative, etc. So it can’t offer the demand of real operation in the underwriting and claim process.
The law of insurance has already opened that the non-life insurance can operate the personal accident insurance after revision two times in our country. Moreover, we believe that will be passed through about the non-life insurance also can operate the health insurance by the legislative rapidly. After the analysis, the conclusion of this research is finding out the question and reason of operation and offering the suggestion of improvement. I hope it can provide some recommendations for the non-life insurance that will operate the personal accident insurance or oncoming of the health insurance.
Key words: Personal Accident Insurance、Combined Ratio、Excess of Loss
| Identifer | oai:union.ndltd.org:CHENGCHI/G0094932218 |
| Creators | 廖舷安, Liao,Hsuan An |
| Publisher | 國立政治大學 |
| Source Sets | National Chengchi University Libraries |
| Language | 中文 |
| Detected Language | English |
| Type | text |
| Rights | Copyright © nccu library on behalf of the copyright holders |
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