CN102057391A - 管理保险方案的***和方法 - Google Patents
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Abstract
一种管理保险制度的***,该***包括保险费模块,其为受保人限定至少一个保险事故并限定在保险事故的其中之一发生时将支付的至少一笔保险费。监控模块监控受保人对健康计划的执行情况。计算模块基于受保人对健康计划的参与程度来改变至少一笔保险费,该***还包括授予模块,其在至少一个保险事故发生时,将至少一笔改变的保险费提供给受保人。
Description
技术领域
本发明涉及一种管理保险方案的***和方法。
背景技术
本发明可以由传统的人寿保险计划操作员为其参保会员实施,或可以由另一方实施。
传统地,保险单(例如,人寿保险单)基于如下方式操作:在被保险人(有时叫做受保人)向人寿保险承保人支付保险金,并且当保险事故发生时,人寿保险承保人对受保人或他/她的受益人支付预定金额(叫做保险金额)。典型的保险事故是:受保人遭受伤残、患上的严重疾病或者死亡。
显而易见地,承保人和受保当事人最希望的是保险事故不会发生。降低该风险的一种方式是受保人要注意其健康。
然而,受保当事人需要一些动力来注意其健康,尽管不这么做存在风险。
本发明提供一种致力于此的***和方法。
发明内容
根据一个示例实施方式,一种管理保险方案的***包括:
保险费模块,针对受保人限定至少一个保险事故,并限定在发生保险事故的其中一个时将被支付的至少一笔保险费;
监控模块,监控受保人对健康计划(wellness programme,保健项目)的执行情况(compliance);
计算模块,基于受保人对健康计划的参与程度来改变至少一笔保险费;以及
授予模块(award module),在至少一个保险事故发生时,对受保人提供至少一笔改变的保险费。
监控模块可以通过接收与受保人的健康计划使用相关联的受保人使用信息,来监控受保人对健康计划的执行情况。
所接收的使用信息典型地包括与受保人参与的多个独立且不同的健康计划相关联的信息。
在一个实例中,监控模块基于使用信息来确定与健康计划的受保人相关联的点值或状态等级,其中,点值或状态等级表示健康计划中的参与程度,并且其中,计算模块使用点值或状态等级来计算百分比的量,然后,计算模块将所述至少一笔保险费改变一百分比,其中,百分比的量与受保人对健康计划的参与程度相关。
在一个实例中,监控模块通过以下方式监控受保人对健康计划的执行情况:
接收与受保人在健康计划中的参与相关的受保人参与信息;并且
基于参与信息来确定与健康计划的受保人相关联的状态等级,其中,状态等级表示在健康计划中的参与程度。
在此实例中,计算模块基于状态等级来改变至少一笔保险费。
根据另一示例实施方式,管理保险方案的设备包括:
用于针对受保人限定至少一个保险事故并用于限定在保险事故的其中一个发生时将被支付的至少一笔保险费的装置;
用于监控受保人对健康计划的执行情况的装置;
用于基于受保人对健康计划的参与程度来改变至少一笔保险费的装置;以及
用于在至少一个保险事故发生时向受保人提供至少一笔改变的保险费的装置。
根据另一示例实施方式,一种管理保险方案的方法包括:
针对受保人限定至少一个保险事故;
限定在至少一个保险事故发生时将被支付的至少一笔保险费;
基于受保人对健康计划的参与程度来改变至少一笔保险费;以及
在至少一个保险事故发生时,向受保人提供改变的至少一笔保险费。
可以将至少一笔保险费改变一百分比,其中,百分比的量与受保人对健康计划的参与程度相关。
该方法还可以包括监控受保人对健康计划的执行情况。
在一个实例中,监控受保人对健康计划的执行情况包括:
接收与受保人在健康计划中的参与相关联的受保人参与信息;
基于参与信息来确定与健康计划的受保人相关联的状态等级,其中,状态等级表示在健康计划中的参与程度;以及
基于状态等级来改变至少一笔保险费。
所接收的参与信息可以包括与受保人参与的多个独立且不同的健康计划相关联的信息。
附图说明
图1是示出了一个示例实施方式的方法的流程图;
图2是示出了一个实施这里描述的方法的示例***的框图。
具体实施方式
这里描述的***和方法涉及一种管理保险方案(例如,人寿保险方案,这是列举的实例)的***和方法。
传统的人寿保险方案基于如下方式操作:被保险人(叫做受保人)按照定期的原则向人寿保险承保人支付保险金,并明确保证金额,该保证金额是保险事故发生时将要支付的数额。例如,在受保人死亡时,对受保人的指定受益人支付预定的死亡保险费。如果受保人残疾或遭受严重的疾病,那么支付相同或不同的数额。
将参考这些类型的方案来描述本方法和***,但是,将理解,该方法和***可等同地应用于其他类型的保险方案。
还将理解,该***和方法可以由任何相关的人或组织实施。例如,该***和方法可以由操作人寿保险方案的组织操作,或者可以由另一相关组织实施。在一个实例中,该***和方法可以由对其会员发放***的金融组织实施。
仅为了说明的目的,这里将把该***和方法描述为由人寿保险方案的管理人员操作。
参考图1,限定了至少一个保险事故(方框10)。典型地,限定多个保险事故,在该实例中,多个保险事故包括伤残、患上严重疾病或者死亡,因为这些事件是由人寿保险方案保护的典型的事件类型。然而,将理解,在其他背景中,这些保险事故可以是其他事件,例如,小孩的出生或改变工作,这仅是列举的几个实例。
在任何事件中,对于方案的受保人来说,保险事故的发生都导致将对受保人支付至少一笔保险费。
至少一笔保险费可以是任何种类的保险费。例如,至少一笔保险费可以是单独的一次性付款的现金支付、定期现金支付的开始、生活费用类别中的费用的至少部分补助、或健康保险计划保险金的补助,这些仅是列举的几个实例。
另外,至少一笔保险费可以是不止一个以上实例的保险费的组合。
至少一笔保险费将支付给受保人或受保人的指定受益人。典型地,为受保人安排保险费,但是,在受保人已经死亡或丧失能力的情况中,将对受保人在事件之前已经指定的受益人支付保险费。
在下一步骤中(方框14),监控受保人对健康计划的执行情况。
目前,这种健康计划的一个实例由本申请人管理,本申请人将传统的人寿和健康保险计划与其健康计划一起管理,所述健康计划在申请人的南非授权专利号ZA 99/1746中公开,该专利的内容以引证方式结合于此。
在一个示例健康计划中,会员参与已批准的相关机构和/或服务。例如,会员使用健身房、戒烟计划(Smoke EndersTM)和减肥计划(WeighlessTM)。
在一个实例中,对会员奖励点数,并且,根据分配给会员的总点数,会员落入五个状态中的其中一个。在健康计划的执行中,以价值的升序来列举这些状态:蓝色、青铜、白银、黄金和钻石。一开始,所有会员都是蓝色状态。一旦会员累积了预定的点数,则他/她的状态就升级至下一适当的等级。
将理解,为了本发明的目的,健康计划可由承保人操作,或者可由操作健康计划的第三方操作,然后第三方向承保人通知受保人对健康计划的参与程度。
这可通过第三方将数据传送至由承保人操作的至少一个服务器22(图2)而发生。在至少一个服务器22处接收数据并将数据储存在与至少一个服务器相关联的数据库32中。
在一个实例中,数据将至少包括受保人的身份和确认受保人的状态的数据,例如蓝色、青铜、白银、黄金和钻石。
为了确定状态,监控受保人对健康计划的执行情况包括:接收与受保人的健康计划的使用相关联的受保人使用信息,并基于使用信息来确定与健康计划的受保人相关联的状态等级,其中,状态等级表示健康计划中的参与程度。
所接收的使用信息可以包括与受保人参与的多个独立且不同的健康计划相关联的信息。
另外,本方法可以进一步包括确定与受保人相关联的状态等级,其进一步包括:从信息处理***接收使用信息,并将给定的点值分配给所参与的每个独立且不同的健康计划。
基于分配给所参与的每个单独且不同的健康计划的每个给定点值的累积来确定总点值。
然后,将总点值与多个点范围进行比较,多个点范围中的每个点范围与一状态等级相关联,并确认多个点范围中的与总点值相对应的一个点范围。
最后,将与已经确认的点范围相关联的状态等级分配给至少一个雇员。
基于受保人对健康计划的参与程度来改变至少一笔保险费(方框16)。
在一个实例中,可以将至少一笔保险费改变一百分比,其中,该百分比的量与受保人对健康计划的参与程度相关。
在另一示例实施方式中,可以用如下所述的计算公式来改变至少一笔保险费。为了说明的目的,将把至少一笔保险费描述为一定量的货币(称为人寿基金)。
公式1:年度调整=人寿基金(对于该周年,在ABI之前)×综合保证金%×活力调整%。
ABI是自动保险费增加,典型地,其基于保单期限和条件而年度地发生。
综合保证金%(Integrated Cover%,综合保证金百分比)指的是附加保证金或表示成主保证金额的百分比的保证金额。即,附加保险费综合保证金/人寿基金。
活力调整(Vitality Adjustment,生命力调整)是健康计划调整,并由下表确定:
活力状态 | 蓝色 | 青铜 | 白银 | 黄金 | 钻石 |
活力调整 | 3.75% | 2.75% | 1.50% | 0.00% | -0.75% |
由于以上百分比在以下公式中的使用,因此,负百分比将增加总保证金,而正百分比将减小总保证金。
公式2:一周年之后的综合保证金=(综合保证金(周年之前)-年度调整)×(1+ABI)。
对于以下一组事实,应用以上公式1和2的一个实例如下:
登入年龄(最近的)=41
人寿基金=R1000000
额外的综合保证金是人寿基金(周年之前)的20%=R200000
保险费增加率(ABI)=10%
90天时的活力状态=青铜
应用公式1,得到:
年度调整(1周年)=R5500(R100000×20%×2.75%)
综合保证金(在1周年之后)=(R200000-R5500)×(1+10%)=R213950
人寿基金(在1周年之后)=R1100000
年度调整(2周年)=R6050(R1100000×20%×2.75%)
综合保证金(在2周年之后)=R228690(=(R213950-R6050)×(1+10%))。
在一个示例实施方式中,可以应用一定的最大和最小增加。
在保险事故发生的情况下,对于受保人证明至少一笔改变的保险费。
将理解,不论用什么方法来改变上述至少一笔保险费,在保险事故发生时,这都将对受保人产生更大的保险费。然而,通常对于保险型计划来说,如果保险事故没有发生,那么受保人将不会得到保险费。
为了增强上述方法的动机因素,在没有发生保险事故的情况下,可以许多预定方式中的任何一种对处于预定年龄的受保人提供改变的保险费。
在一个实例中,由于受保人遵守健康计划而积累的额外保险费被用来确定提供给处于预定年龄的受保人的附加保险费。典型地,仅在没有发生保险事故的情况下,或者已经发生少于有限预定数量的保险事故的情况下,提供上述附加保险费。
在一个示例实施方式中,预定年龄可以是65,这是典型的退休年龄。
因此,在积累的额外保险费是超过并超越基线受保数额的一百分比的情况中,将向受保人提供此额外的百分比。替代地,积累的额外保险费可以以某些方式量化并取决于该数量,可以将不同的数额作为附加保险费提供给受保人。
附加保险费可以是以下的一种或多种:
用于健康保险计划基金的数额;
用于退休基金的数额;
为任何未来的保险事故保留额外保险费;以及
以上的组合。
为了示出使用健康保险计划基金的数额的实例,可用下表计算健康保险计划基金:
典型地,在承保人也提供健康保险或者与提供健康保险的另一实体相关联的情况下,应用上述表格,这是为什么这个数额反映成健康折扣的原因。如果情况不是这样,则更有可能用这个数额减少对健康承保人的支付。
将理解,虽然将额外的或剩余的保证金的多个段(band)转换成将用于健康折扣的百分比,但是该百分比(例如)将是对为健康保险支付的数额的一百分比的折扣。
除了上述内容以外,该方法可以包括,基于受保人对于其健康保险计划所要求的数额来改变至少一笔保险费。在此实例中,要求的数额越低,保险费将越高。
例如,可将要求的总数额安排在多个范围中,其中,一百分比与每个范围相关联,该百分比是将用来改变保险费的百分比。
另外,可激励受保人定期进行健康评估,并且,如果受保人确实遵守了,则这也用来改变保险费。
将注意,对保险费的调整在要求之前计算,并且与具体的要求不相关。仅有健康计划中的约定会影响保险费调整,而上述约定不是具体的要求。
最后,在受保人具有由承保人或相关联公司发放的***的情况下,***上的花费可用来改变保险费。
图2示出了用于实施以上方法的示例性***。
服务器22包括用以执行上述方法的许多模块。
保险费模块24针对受保人限定多个保险事故,并限定在保险事故的其中一个发生的情况下将支付的至少一笔保险费。
将模块24构造为限定多个保险事故,在一个实施方式中,多个保险事故包括伤残、患上严重疾病或者死亡,这些是由人寿保险方案保护的典型的事件类型。然而,将理解,在其他背景中,这些生命改变事件可以是其他事件。
一旦保险费模块24限定了多个生命改变事件,模块24便访问存储器并将所限定的多个费用类别存储在存储器中。
在一个示例实施方式中,存储器可采用数据库32的形式。在其他实施方式中,存储器可位于服务器20上,或位于未在此实例***中示出的另一服务器上。在任一情况中,存储器与模块24数据通讯,并可被能够对存储器读写数据的模块24访问。
具体地将监控模块26构造为,限定健康计划并监控受保人对健康计划的执行情况。
受保人对健康计划的执行情况的监控包括:通过监控模块26接收与受保人的健康计划的使用相关联的受保人使用信息。
所接收的使用信息可以包括与受保人参与的多个单独且不同的健康计划相关联的信息。
监控模块26基于使用信息来确定与健康计划的受保人相关联的点值或状态等级,其中,上述点值或状态等级表示在健康计划中的参与程度。
另外,可以将监控模块26进一步构造为通过如下方式来确定与受保人相关联的状态等级:从信息处理***接收使用信息,并将给定的点值分配给所参与的每个单独且不同的健康计划。
基于分配给所参与的每个单独且不同的健康计划的每个给定点值的累积,通过监控模块26确定总点值。
然后,通过监控模块26将总点值与多个点范围进行比较,所述多个点范围中的每个点范围均与一状态等级相关联,进而确认多个点范围中的与总点值相对应的一个点范围。
最后,通过监控模块26将与已经确认的点范围相关联的状态等级分配给至少一个雇员。
然后,监控模块26将总点值或状态等级写入存储器,例如数据库32。
在任一情况中,计算模块26访问存储器并检索所存储的总点值或状态等级。
将计算模块28构造为,基于受保人对健康计划的参与程度来改变至少一笔保险费,如上所述。
在保险事故发生的情况下,授予模块30将至少一笔改变的保险费提供给受保人。
在一个实例中,授予模块30经由通信网络(例如,通信网络34)连接至金融机构,该金融机构命令向受保人或其指定受益人支付现金数额。
该***包括至少一个相关联数据库32,该数据库32其用于存储由一个或多个以上参考的模块使用的数据。
另外,服务器典型地连接至通信网络34,以与其他计算机通信,从而执行上述方法。
可以用将指令具体化的机器可读的介质来实施上述模块,当机器执行所述指令时,这些指令导致机器执行上述方法任一种。
将理解,本发明的实施方式不限于这种架构,并且,可同样良好地应用于分布式或对等网络的架构***。因此,所说明的模块可位于由一个或多个机构操作的一个或多个服务器上。
在另一示例实施方式中,可以用被专门编程以执行这里描述的方法的固件来实施这些模块。
还将理解,在任何这些情况中,这些模块形成一物理设备,该物理设备具有专门用于执行这里描述的方法的步骤的物理模块。
Claims (13)
1.一种管理保险方案的***,其特征在于,所述***包括:
保险费模块,为受保人限定至少一个保险事故,并限定在所述保险事故的其中之一发生的情况下将支付的至少一笔保险费;
监控模块,监控所述受保人对健康计划的执行情况;
计算模块,基于所述受保人对所述健康计划的参与程度来改变所述至少一笔保险费;以及
授予模块,在所述至少一个保险事故发生的情况下,将改变后的所述至少一笔保险费提供给所述受保人。
2.根据权利要求1所述的***,其中,所述监控模块通过接收与所述受保人的健康计划的使用相关联的受保人使用信息,来监控所述受保人对所述健康计划的所述执行情况。
3.根据权利要求2所述的***,其中,接收的所述使用信息包括与所述受保人参与的多个独立且不同的健康计划相关联的信息。
4.根据权利要求2或3所述的***,其中,所述监控模块基于所述使用信息来确定与所述健康计划的所述受保人相关联的点值或状态等级,其中,所述点值或所述状态等级表示在所述健康计划中的参与程度,并且其中,所述计算模块使用所述点值或状态等级来计算所述百分比量。
5.根据权利要求4所述的***,其中,所述计算模块将所述至少一笔保险费改变一百分比,其中,所述百分比的量与所述受保人对所述健康计划的所述参与程度相关。
6.根据前述权利要求中任一项所述的***,其中,所述监控模块通过以下方式监控所述受保人对所述健康计划的所述执行情况:
接收与所述受保人在所述健康计划中的参与相关联的受保人参与信息;并且
基于所述参与信息来确定与所述健康计划的所述受保人相关联的状态等级,其中,所述状态等级表示在所述健康计划中的参与程度。
7.根据权利要求6所述的***,其中,所述计算模块基于所述状态等级来改变所述至少一笔保险费。
8.一种管理保险方案的设备,其特征在于,所述设备包括:
用于针对受保人限定至少一个保险事故并限定在所述保险事故的其中之一发生的情况下将支付的至少一笔保险费的装置;
用于监控所述受保人对健康计划的执行情况的装置;
用于基于所述受保人对所述健康计划的所述参与程度来改变所述至少一笔保险费的装置;以及
用于在所述至少一个保险事故发生时将改变后的所述至少一笔保险费提供给所述受保人的装置。
9.一种管理保险方案的方法,其特征在于,所述方法包括:
针对受保人限定至少一个保险事故;
限定在所述至少一个保险事故发生时将支付的至少一笔保险费;
基于所述受保人对健康计划的参与程度来改变所述至少一笔保险费;以及
在所述至少一个保险事故发生时,将改变后的所述至少一笔保险费提供给所述受保人。
10.根据权利要求9所述的方法,其中,将所述至少一笔保险费改变一百分比,其中,所述百分比的量与所述受保人对所述健康计划的参与程度相关。
11.根据权利要求9或10所述的方法,其中,所述方法包括监控所述受保人对所述健康计划的执行情况。
12.根据权利要求11所述的方法,其中,所述监控所述受保人对所述健康计划的所述执行情况包括:
接收与所述受保人在所述健康计划中的参与相关联的受保人参与信息;
基于所述参与信息来确定与所述健康计划的所述受保人相关联的状态等级,其中,所述状态等级表示在所述健康计划中的参与程度;以及
基于所述状态等级来改变所述至少一笔保险费。
13.根据权利要求12所述的方法,其中,接收的所述参与信息包括与所述受保人参与多个单独且不同的健康计划相关联的信息。
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2009
- 2009-05-28 CN CN2009801206564A patent/CN102057391A/zh active Pending
- 2009-05-28 WO PCT/IB2009/052247 patent/WO2009147591A2/en active Application Filing
- 2009-05-29 ZA ZA200903752A patent/ZA200903752B/en unknown
- 2009-06-03 AU AU2009202206A patent/AU2009202206A1/en not_active Abandoned
- 2009-06-03 US US12/477,208 patent/US8190455B2/en active Active
Cited By (1)
Publication number | Priority date | Publication date | Assignee | Title |
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WO2017157030A1 (zh) * | 2016-03-18 | 2017-09-21 | 深圳市前海安测信息技术有限公司 | 医疗保险费折扣精算***及方法 |
Also Published As
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AU2009202206A1 (en) | 2009-12-17 |
WO2009147591A2 (en) | 2009-12-10 |
US8190455B2 (en) | 2012-05-29 |
WO2009147591A3 (en) | 2010-02-04 |
US20090299775A1 (en) | 2009-12-03 |
ZA200903752B (en) | 2010-04-28 |
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