平安人寿重大疾病保险产品运营研究

发布时间：2018-01-27 09:27

本文关键词： 重大疾病保险产品运营完善建议　出处：《贵州财经大学》2015年硕士论文　论文类型：学位论文

【摘要】：重大疾病保险(简称重疾险)一直是深受人们欢迎的人身险产品之一,自从1995年引入我国以来一直是保险公司的销售热点。随着现代社会发病率的日渐提高,以及医疗费用的不断攀高,很多人看不起病,尤其是在一些城市低收入阶层和广大农民群众中,“因病致贫、一病返贫”的现象还很突出,重大疾病保险作为一个转嫁风险的有效途径,其健康发展就具有非常重大的社会意义。重疾险产品现已成为我国人身保险市场重要的保障型产品,2012年保费收入406亿元,占我国健康保险保费的54.7%。我国也成为全世界最大的重大疾病保险市场。2006年,《重大疾病保险的疾病定义使用规范》的出台,使得重大疾病的定义有了全行业统一的标准,减少了人们选购产品时的麻烦,减少了理赔纠纷。2013年11月,“中国人身保险业重大疾病经验发生率表(2006—2010)”的发布,为各寿险公司重疾险产品科学合理的精算定价提供了基础数据。然而,目前重大疾病保险在产品设计、产品定价、产品销售和售后服务等方面仍然存在许多问题,本文以中国平安寿险贵州分公司为例,通过调查问卷和访谈等方法,对重大疾病保险产品运营各环节进行调查研究从而发现问题及问题出现的原因,并提出有针对性的建议,以期为重大疾病保险业务的健康发展提供有益的参考。文章以一家保险公司(中国平安人寿贵州分公司)为例,从公司和客户两个角度来审视重大疾病保险存在的问题,分别采用访谈法(公司内部员工)和问卷调查法(公司的客户)来了解重疾险的现状、存在问题及原因,最终这些问题通过产品设计、产品定价、产品销售、理赔服务四个环节来贯穿和分类,然后分别从产品设计、产品定价、产品销售、理赔及后续服务四个方面提出完善建议。但是问题研究和完善建议没有严格的一一对应,而是互有交叉。本文主要内容有五部分：第一部分为绪论,包括选题背景与研究意义、文献综述、研究思路与研究方法、创新和不足。第二部分是重大疾病保险的相关概述与理论基础,对重疾险内涵、产品形态、保险责任作了简单介绍,而后对本文的理论基础作了阐述：信息不对称理论和整体营销理念。第三部分重大疾病保险的产品简介与产品运营问题研究,以中国平安人寿贵州分公司为例,首先,介绍了重大疾病保险的发展现状、举例介绍了重疾产品；其次,通过访谈法和问卷调查法找出重疾险存在的问题；最后在此基础上,从产品设计、产品定价、产品销售和理赔服务四个方面对重疾险运营存在的问题作了分析研究。第四部分重大疾病保险产品运营完善建议,从产品设计、产品定价、产品销售、理赔及后续服务四个方面提出了建议。第五部分为总结与展望。本文的创新之处主要有以下几点：资料方面,本文以中国平安人寿贵州分公司为例,运用最新的重疾险产品(如“平安福健康保障计划2014")对其存在问题加以具体分析。结构布局方面,对重大疾病保险运营存在的问题,从产品设计、产品定价、产品销售和理赔服务四个环节加以贯穿和阐述,从产品设计、产品定价、产品销售、理赔及后续服务四个方面给出建议。观点方面,笔者通过与公司内部人士访谈得知,理赔环节的主要问题是赔付率较高与理赔纠纷较多。理赔率较高的原因与发病率、逆选择和道德风险、销售和核保都有关系,理赔纠纷的主要原因是不实告知、客户对合同的误解、合同本身的不合理、销售误导等。针对现代社会发病率日益提高的状况,笔者建议对重疾险客户进行健康管理,例如健康档案管理服务、针对高端客户的服务等——以降低发病率,提高生命质量,最终降低赔付率。本文的不足之处在于调查问卷的数量有些不足,对问卷缺乏更深入的量化分析,再就是部分对策建议稍显笼统,不够具体。
[Abstract]:Serious illness insurance (referred to as critical illness insurance) has been one of the popular personal insurance products, since 1995, China has been the introduction of hot sales of insurance companies. With the development of modern society, the incidence is rising, and rising medical costs, many people can not afford, especially in some low-income City and the broad masses of peasants, "poverty caused by a disease, poverty" phenomenon is also very prominent, serious illness insurance as an effective way of shifting risk, its healthy development is of great social significance. Critical illness insurance product has become China's important security products insurance market, 2012 premium income 40 billion 600 million yuan, accounting for health insurance premiums in China 54.7%. China has become the world's largest major disease insurance market.2006, "disease definition of major disease insurance use specification issued to Definition of major diseases have the whole industry standard, reduce the purchase of products of trouble, reduce claims disputes.2013 in November, "the major disease insurance industry Chinese incidence table (2006 - 2010)" issued, provided the basic data for the life insurance actuarial pricing of critical illness insurance products scientific and reasonable. However, the current major disease insurance in product design, product pricing, there are still many problems of product sales and customer service service, based on the Chinese Guizhou branch of Ping An insurance company as an example, through the questionnaire and interview method, investigation and Research on various aspects of major disease insurance products in order to find the causes of operation problems and problems, and put forward some suggestions, in order to offer reference for the healthy development of major disease insurance business. According to an insurance company (China Ping An Life Guizhou branch) as an example, to examine the existence of serious illness insurance from the two aspects of company and customer, respectively, using interviews (employees) and questionnaires (clients) to understand the status of critical illness insurance, problems and causes of these problems, finally through product design, product pricing. Product sales, claims service four links to penetration and classification, and then from the product design, product pricing, product sales, the four aspects of Follow-Up Services claim and puts forward some improvement suggestions. But research suggests and improve the problem there is not a strict one-to-one correspondence, but cross each other. The main content of this paper has five parts: the first part is the introduction, including research background and significance, literature review, research ideas and research methods, innovations and shortcomings. The second part is the overview of major disease insurance and critical illness insurance on the theoretical foundation, connotation, products Form of liability insurance are introduced, then the theoretical basis of this paper expounds: the theory of asymmetric information and the overall marketing concept. Product introduction and product third major health insurance operations research problems, China in Guizhou Ping An Life Insurance Company for example, first, introduces the development status of major disease insurance, for example the critical illness products; secondly, through interviews and questionnaires to identify critical illness insurance problems; finally, from product design, product pricing, the four aspects of product sales and service claims were analyzed for critical illness insurance operational problems. The fourth part major disease insurance products operation suggestions from product design, product pricing, product sales, and puts forward some suggestions in four aspects of claims and Follow-Up Services. The fifth part is the conclusion and prospect. The main innovations of this article are to Some data, this paper takes Guizhou China Ping An Life Insurance Company as an example, using the latest critical illness insurance product (such as "Fu Ping An health insurance plan 2014") on the existing problems in detail. The layout of the structure, the existence of serious illness insurance operations, from product design, product pricing. Product sales and service claims four aspects and through the elaboration, from product design, product pricing, product sales, the four aspects of claims and give advice. Follow-Up Services point of view, the author of the interview with the company insiders that the main problem is the high rate of payment of claims and claims disputes claims a higher rate of reason more. And the incidence of adverse selection and moral hazard, are related to sales and underwriting, mainly due to claims disputes is not informed of the contract, the contract itself misunderstood customers, unreasonable, misleading sales. In modern society, the incidence rate increased, the author suggests to carry out health management for critical illness insurance customers, such as health management services for high-end customers service such as: to reduce morbidity, improve the quality of life, and ultimately reduce the loss rate. The shortcoming of this paper lies in the fact that the number of the questionnaire on some deficiencies, more quantitative analysis the lack of in-depth questionnaire, then some advice somewhat vague, not specific enough.

【学位授予单位】：贵州财经大学
【学位级别】：硕士
【学位授予年份】：2015
【分类号】：F842.3

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