CN111652744B

CN111652744B - Health insurance product configuration method, device, medium and equipment

Info

Publication number: CN111652744B
Application number: CN202010465850.4A
Authority: CN
Inventors: 董楠; 高英明; 欧龙平; 王一涵; 徐义博
Original assignee: Taikang Insurance Group Co Ltd
Current assignee: Taikang Insurance Group Co Ltd
Priority date: 2020-05-28
Filing date: 2020-05-28
Publication date: 2023-09-12
Anticipated expiration: 2040-05-28
Also published as: CN111652744A

Abstract

The invention relates to a health risk product configuration method, a device, a medium and equipment. When receiving a health insurance product configuration request sent by a terminal side, the server side can respond to a responsibility plan configuration page to the terminal side, each insurance responsibility in the responsibility plan configuration page can correspond to an insurance responsibility tree with a hierarchical structure, and can receive configuration information sent by the terminal side and corresponding to the responsibility plan configuration page to configure the insurance responsibility tree. Therefore, the configuration of the insurance responsibility tree can be used for realizing the hierarchical configuration of insurance responsibility in the health insurance products, and the accuracy of the configuration of the health insurance products is improved.

Description

Health insurance product configuration method, device, medium and equipment

Technical Field

The present invention relates to the field of communications technologies, and in particular, to a health risk product configuration method, apparatus, medium, and device.

Background

The premium calculation and claims of health insurance products are different from the traditional insurance products, and are mainly represented by the fact that the health insurance calculation is related to the occurrence rate of diseases and the change of medical expenses related to the health condition and behavior habit of people, and the factors needing to be considered are more, so that the premium calculation and claims are more complicated.

The statistical data shows that the occurrence rate of the medical insurance claim is 6-8%, wherein the supplementary medical insurance business of enterprises is up to 25-30%, which is far higher than the level of life insurance by 0.3-0.4%, and the frequent claim settlement also determines that a great amount of manpower and material resources are required to be invested in the aspect of claim settlement.

The existing health insurance products are obtained by modifying the traditional life insurance products, and the insurance responsibility is not refined enough, so that the accurate configuration of the health insurance products can not be realized.

Disclosure of Invention

The embodiment of the invention provides a health risk product configuration method, a device, a medium and equipment, which are used for solving the problem that the health risk product configuration is inaccurate.

The invention provides a health risk product configuration method, which comprises the following steps:

receiving a health insurance product configuration request sent by a terminal;

responding to a responsibility plan configuration page to the terminal according to the received health insurance product configuration request, wherein each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure;

receiving configuration information corresponding to the responsibility plan configuration page sent by the terminal, wherein the configuration information comprises configuration of the insurance responsibility tree;

The configuration of the insurance responsibility tree included in the configuration information includes calling information of preconfigured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility.

In a preferred embodiment, each level of an insurance responsibility tree includes at least one insurance responsibility.

In a preferred embodiment, the configuration information configures insurance responsibilities including healthcare details for claims.

In a preferred embodiment, the responsibility plan configuration page further includes configuration of insurance responsibility rules;

the configuration information further includes a configuration of insurance liability rules, wherein one insurance liability rule of the configuration corresponds to at least one insurance liability.

In a preferred embodiment, the responsibility plan configuration page further comprises configuration of responsibility plan basic information and configuration of rate;

the configuration information also includes configuration of responsibility plan basic information and configuration of rates.

In a preferred embodiment, if at least one of the configuration of the insurance responsibility rules, the configuration of the responsibility plan basic information and the configuration of the rate included in the responsibility plan configuration page includes a predefined insurance factor, the configuration information includes a configuration of the predefined insurance factor;

The insurance factors include at least one of a underwriting factor, a claims factor, and a rate factor.

In a preferred embodiment, the method further comprises:

responding to a dangerous seed basic information configuration page to the terminal according to the received health dangerous product configuration request;

and receiving configuration information corresponding to the dangerous seed basic information configuration page sent by the terminal.

In a preferred embodiment, the method further comprises:

acquiring verification information corresponding to the received configuration information, and taking the received configuration information as the configuration information of the health insurance product if the verification information is verification passing;

the verification information is obtained by verifying the correctness of the received configuration information.

In a preferred embodiment, verifying the correctness of the received configuration information comprises:

simulating the application process and the claim settlement process of the health insurance product according to the received configuration information, and verifying the correctness of the received configuration information according to the application process and the claim settlement process.

The invention also provides a health risk product configuration device, which comprises:

The receiving module is used for receiving a health insurance product configuration request sent by the terminal; receiving configuration information corresponding to a responsibility plan configuration page sent by the terminal;

the response module is used for responding to a responsibility plan configuration page to the terminal according to the received health insurance product configuration request, wherein each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure;

the configuration information comprises the configuration of the insurance responsibility tree;

The present invention also provides a non-volatile computer storage medium storing an executable program that is executed by a processor to implement the method as described above.

The invention also provides health insurance product configuration equipment, which comprises at least one processor; and a memory communicatively coupled to the at least one processor; wherein the memory stores instructions executable by the at least one processor to enable the at least one processor to perform the steps of the method as described above.

According to the scheme provided by the embodiment of the invention, when the server side receives the health insurance product configuration request sent by the terminal side, the server side can respond to the responsibility plan configuration page to the terminal side, each insurance responsibility in the responding responsibility plan configuration page can correspond to one insurance responsibility tree with a hierarchical structure, and can receive the configuration information corresponding to the responding responsibility plan configuration page sent by the terminal side, so that the configuration of the insurance responsibility tree is realized. Therefore, the hierarchical configuration of insurance responsibility in the health insurance product can be realized through the configuration of the insurance responsibility tree, and the accuracy of the configuration of the health insurance product is improved through the refined configuration of the insurance responsibility.

Additional features and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objectives and other advantages of the invention will be realized and attained by the structure particularly pointed out in the written description and claims thereof as well as the appended drawings.

Drawings

In order to more clearly illustrate the embodiments of the invention or the technical solutions in the prior art, the drawings that are required in the embodiments or the description of the prior art will be briefly described, it being obvious that the drawings in the following description are only some embodiments of the invention, and that other drawings may be obtained according to these drawings without inventive effort for a person skilled in the art.

Fig. 1 is a flow chart of a health risk configuration method according to an embodiment of the invention;

FIG. 2 is a schematic diagram of a configuration page according to a first embodiment of the present invention;

FIG. 3 is a diagram of a rate configuration prototype design page according to one embodiment of the present invention;

FIG. 4 is a schematic diagram of a responsibility plan configuration page according to a first embodiment of the present invention;

FIG. 5 is a schematic diagram of a health risk configuration design according to a second embodiment of the present invention;

FIG. 6 is a schematic diagram illustrating a health risk configuration process according to a second embodiment of the present invention;

fig. 7 is a schematic structural diagram of a health risk configuration device according to a fourth embodiment of the present invention;

fig. 8 is a flow chart of a health risk configuration method according to a fifth embodiment of the present invention;

fig. 9 is a schematic structural diagram of a health risk configuration device according to a sixth embodiment of the present invention;

fig. 10 is a schematic structural diagram of a health risk configuration device according to a seventh embodiment of the present invention.

Detailed Description

Because the insurance responsibility is not refined enough and the accurate configuration of the health insurance products cannot be realized when the health insurance products are obtained by modifying the traditional life insurance products, the invention provides a health insurance product configuration scheme, the refinement of the insurance responsibility can be realized through the hierarchical configuration of the insurance responsibility, the accuracy of the health insurance product configuration is improved, and the refined automatic matching of service items and the insurance responsibility of the hierarchical configuration can be carried out during the claim settlement, thereby achieving the aim of effective cost control.

In embodiments of the present invention, a liability plan may be understood as a product and an insurance liability may be understood as a definition of a guaranteed content of the product. One liability plan may correspond to at least one insurance liability.

Furthermore, in the scheme of the invention, the further refinement of the insurance responsibility can be realized by carrying out the detail configuration of the medical service in the insurance responsibility.

In addition, in the scheme of the invention, the insurance factors and the preconfigured insurance responsibilities can be predefined, and when the configuration of the health insurance products is realized, the system resources are saved and a large number of repeated works are reduced by multiplexing the predefined insurance factors and the preconfigured insurance responsibilities.

In various embodiments of the present invention, insurance factors may be understood as influencing parameters commonly used in insuring and claiming, and may include, but are not limited to, underwriting factors, claiming factors, and rate factors.

A underwriting factor may be understood as a parameter used in the course of underwriting. For example, if a health insurance product only allows people under 60 years old to make insurance, an age factor is needed to block people older than 60 years old from making insurance, and then the age can be used as a insurance factor.

A core claim factor may be understood as a parameter used in the process of a core claim. For example, if a health risk product belongs to accident risk and the accident cause is not accident, the accident cause can be used as a core claim factor. Then the accident source selected when the insured case is declared is non-unexpected and no claims are made.

The term "claim factor" is understood to mean some limiting parameter that is calculated when the insured life claims. For example, if the guard of a health insurance product is 2000 yuan, the guard can be used as a claim factor. The term free, number of days free, sub-limits, daily limits, odds ratio, etc. are also understood as the term factors.

The rate factor may be understood as an influencing parameter of the premium for calculating the premium that the applicant needs to pay during the application process. For example, smoking may increase the risk of developing certain diseases, and whether smoking is a rate factor may be defined as whether smoking is at a different rate, i.e., a different premium.

In order to make the objects, technical solutions and advantages of the present invention more apparent, the present invention will be described in further detail below with reference to the accompanying drawings, and it is apparent that the described embodiments are only some embodiments of the present invention, not all embodiments. All other embodiments, which can be made by those skilled in the art based on the embodiments of the invention without making any inventive effort, are intended to be within the scope of the invention.

It should be noted that, as used herein, reference to "a plurality of" or "a plurality of" means two or more. "and/or", describes an association relationship of an association object, and indicates that there may be three relationships, for example, a and/or B, and may indicate: a exists alone, A and B exist together, and B exists alone. The character "/" generally indicates that the context-dependent object is an "or" relationship.

The terms first, second and the like in the description and in the claims and in the above-described figures, are used for distinguishing between similar elements and not necessarily for describing a particular sequential or chronological order. It is to be understood that the data so used may be interchanged where appropriate such that the embodiments of the invention described herein may be implemented in sequences other than those illustrated or otherwise described herein.

Furthermore, the terms "comprises," "comprising," and "having," and any variations thereof, are intended to cover a non-exclusive inclusion, such that a process, method, system, article, or apparatus that comprises a list of steps or elements is not necessarily limited to those steps or elements expressly listed but may include other steps or elements not expressly listed or inherent to such process, method, article, or apparatus.

Example 1

An embodiment of the present invention provides a health risk configuration method, where the flow of steps of the method may be as shown in fig. 1, including:

step 101, a health risk product configuration request is received.

The present embodiment mainly uses a server as an execution body for explanation. In this step, the server may receive a health risk product configuration request sent by the terminal.

The health insurance product configuration request sent by the terminal may be at the terminal side, where the terminal receives the health insurance product configuration request sent by the user and sends the health insurance product configuration request to the server. The health risk product configuration request received by the terminal may be in any form, and the embodiment is not particularly limited.

Step 102, responding to the configuration page.

In this step, the server may respond to the responsibility plan configuration page to the terminal according to the received health risk product configuration request. On the terminal side, the terminal can receive and display the responsibility plan configuration page responded by the server so as to receive corresponding configuration information according to the responsibility plan configuration page.

The responsibility plan configuration page may be understood as a configuration for configuring a responsibility plan corresponding to a dangerous seed. In order to achieve responsibility refinement, in this embodiment, each insurance responsibility in the responsibility plan configuration page may correspond to an insurance responsibility tree with a hierarchical structure, so that the hierarchical configuration of the insurance responsibility may be achieved through the configuration of the insurance responsibility tree, responsibility refinement is achieved, and automatic management and effective fee control during claim settlement are facilitated.

The responsibility plan configuration page (responsibility plan configuration prototype design page) may correspond to the responsibility plan part in fig. 2, and in responsibility plan 1, under the preventive responsibility of configuration, insurance responsibility (fine responsibility item) of registration filing, general oral examination, full mouth fluorine coating, sulcus closure, ultrasonic tooth cleaning, dental face polishing, and oral health education are configured. That is, by setting up the insurance responsibility tree of the hierarchical structure corresponding to the insurance responsibility, the prevention responsibility can be configured as one insurance responsibility tree of a two-level structure.

Each level of the insurance responsibility tree may be understood to include at least one insurance responsibility. Taking fig. 2 as an example, for the insurance liability tree corresponding to the liability plan 1, the first level may be understood to include two insurance liabilities (preventive liabilities and unexpected liabilities, responsibilities 3 to 5 shown in fig. 2 may be understood to be unconfigured), and further, according to the display of fig. 2, it may be seen that the second level of preventive liabilities may include seven insurance liabilities (registration profiling, general oral examination, full oral fluorine coating, sulcus closure, ultrasonic tooth cleaning, dental polishing, and oral health ventilating).

It should be noted that, the insurance responsibility defines the security content of the dangerous seed, and the responsibility plan configuration page may include the configuration of the insurance responsibility rule in addition to the configuration of the insurance responsibility, so as to define the limitation condition of the dangerous seed. One insurance liability rule may be configured for a single insurance liability and one insurance liability rule may be configured for multiple insurance liabilities if multiple intersections of the insurance liabilities are involved. For example, the shared insurance claim factor involves two insurance responsibilities (two insurance responsibilities correspond to one insurance respectively, but the two insurance responsibilities are limited by one shared insurance), at which time the configuration of claim rules for the two insurance responsibilities is required.

Taking fig. 2 as an example, in the liability plan 1, two insurance responsibilities, namely, preventive responsibilities and unexpected responsibilities, are configured. For preventive liability, the amount of claims (claim settlement factor) needs to be configured, and in the example of fig. 2, it may be configured to be 500 yuan. Furthermore, it is shown in the rule configuration (i.e., insurance responsibility rule configuration) section that the years (claim factors) need to be configured for preventive responsibility and unexpected responsibility, and may be configured as 3000 yuan, for example, in fig. 2.

In this embodiment, the insurance factor may be predefined, so that the insurance factor may be reused, which reduces the time consumption of software development and reduces the complexity thereof.

Therefore, when the configuration of the claim factor is required, the claim factor that already exists (predefined) or the claim factor is newly added may be selected, and the constraint condition may be configured according to the type of the claim factor. For example, a numerical type claim factor, an equal sign operator may be displayed, and an input box appears, prompting the entry of a number in the input box; the claim factor of the interval type can be set by the segmentation rule for different intervals, for example, the claim proportion is 80% within 1000 yuan for medical fee and 90% above 1000 yuan, the interval can be firstly configured, and then the configuration of the claim factor is carried out in the interval. The manner in which the claim factors are configured may be, but is not limited to, as shown in table 1.

TABLE 1 configuration of claim factors

It should be further noted that, in this embodiment, the responsibility plan configuration page may further include configuration of responsibility plan basic information and configuration of rate. The responsibility plan basic information may be configured in a responsibility plan basic information configuration, for example, but not limited to, restrictions (e.g., insurance, claim free, etc.) including claim rules of responsibility plan level, a fixed point hospital configuration, a maintenance factor configuration, and the like.

The fixed point hospital configuration can firstly configure whether the insurance responsibility requires the fixed point hospital, if the fixed point hospital is required to be configured, the fixed point hospital range can be required to be continuously configured, and if the fixed point hospital range is configured, the fixed point hospital number can be required to be continuously configured.

Regarding the configuration of the kernel protection factor, an existing kernel protection factor or a newly added kernel protection factor may be selected first, and then an operator and a conditional configuration may be presented according to the selected kernel protection factor type. For example, if the gender is selected to be male, it may be that the male is not permitted to apply.

The kernel claim factor configuration is similar to the kernel claim factor, an existing kernel claim factor or a newly added kernel claim factor can be selected first, and then operators and condition configurations can be displayed according to the selected kernel claim factor type. For example, if an accident risk requires that the accident cause must be an accident, then the factor of the accident cause, the corresponding value, or values, may be selected to be non-unexpected, representing that no claims are made for the non-accident cause.

The configuration of the core protection factor and the core claim factor may be, but is not limited to, as shown in table 2. Wherein, the value type of the kernel protection factor (or kernel claim factor) can display various operators, and an input box appears to prompt the input of numbers in the input box; whether a type of underwriting factor (or a underwriting factor) may prompt whether to select to facilitate selection at the time of application; the list type of underwriting factor (or core claim factor) may prompt selection of at least one entry in the list.

TABLE 2 configuration of Nuclear protection factors and Nuclear claim factors

In configuring the rate, an existing rate factor may be selected or a new rate factor may be added. Different types of rate factors may exhibit different configurations, and may be, but are not limited to, those shown in Table 3. As in table 3, whether a rate factor of a type may be selected, yes or no, without field configuration, e.g., whether an insurance product's premium is related to whether to smoke, whether to smoke is a factor of a type. When the rate is configured, the user can select whether to smoke or not, and can input in the corresponding cell, what the insurance premium is applied when smoking or not=yes, and what the insurance premium is applied when smoking or not=no; the rate factor of the list type may be selected without field configuration, for example, the premium of an insurance product is related to sex, the sex is a factor of the list type, and the values are male and female, respectively. When the rate is configured, the user can select gender and input the amount of the insurance fee applied by the male and the amount of the insurance fee applied by the female in the corresponding cells; the rate factors of the zone types may be configured with maximum, minimum and stride fields for different zones, for example, the premium of one insurance product is related to the age, for example, 0-18 years old, 18-60 years old, and above 60 years old correspond to different rates, respectively, then the age is a factor of one zone type (of course, the age may also be of a numerical type, different types are selected according to different insurance products), then the age start value, end value and age interval may be configured for pre-generating the age zone, and the generation may be edited.

TABLE 3 configuration of rate factors

Factor type	Configuration field
		Whether or not to use	Without any means for
List of list	Without any means for
		Interval of	Maximum, minimum, stride

In the course of rate configuration, the rate table direction (transverse and longitudinal) can also be configured, and after confirmation, a rate table is generated, and rate factors can be configured on the rate table. The rate configuration also supports the addition of multiple rate tables, avoiding the problems of excessively large rate tables and redundant inputs. For example, if a dangerous seed has an insurance liability and an insurance liability, the insurance liability is related to gender and age, the insurance liability is related to social security, and two tariffs can be configured. The first tariff table is a two-dimensional table with gender and age as the horizontal and vertical table heads, and the second table is a tariff table with the optional insurance responsibility and the existence of social security as the horizontal and vertical table heads. The rates of the two tariffs are additive. The configured tariff table may collect information according to a rate factor at the time of the application, thereby determining the premium that the applicant should pay. The rate configuration prototype design page is illustrated in the box-out section (responsibility plan configuration page) of fig. 3.

As can be seen from the above description of the responsibility plan basic information configuration, the insurance responsibility rule configuration and the rate configuration, in one possible implementation manner, at least one of the configuration of the insurance responsibility rules, the configuration of the responsibility plan basic information and the configuration of the rate included in the responsibility plan configuration page may further include a predefined insurance factor, and the predefined insurance factor may be configured subsequently to implement the configuration of the health insurance product. That is, the configuration of at least one of the insurance responsibility rule, the configuration of the responsibility plan basic information, and the configuration of the rate, which are included in the responsibility plan configuration page, may include the configuration of at least one of a predefined underwriting factor, a claim settlement factor, and a rate factor, so as to reduce the time consumption of software development and reduce the complexity thereof.

In addition, in this step, if the health risk product configuration request is received, the responsibility plan configuration page may be displayed to implement configuration of the responsibility plan, and the risk type basic information configuration page may be displayed to implement configuration of basic information corresponding to the health risk product (risk type).

Some basic attributes of the dangerous seeds, such as policy information, security information, sales information, report information and the like, can be included in the displayed dangerous seed basic information configuration page.

Taking the example that the dangerous basic information configuration page and the responsibility plan configuration page are displayed on the same page, the dangerous basic information configuration page can correspond to the basic information part in fig. 2.

As shown in the basic information part of fig. 2, the configuration page of the basic information of the dangerous seed may include configuration of dangerous seed name, dangerous seed abbreviation, dangerous seed code, english name, english abbreviation, account mark, predetermined interest rate, dangerous class, investment category, long term, short term, personal group, main additional insurance, insurance product code, date of sale, sale mark, sale channel, sale area, insurance application age of the person who is secondarily applied, maximum sustainable age, denomination form, payment period, insurance period, main additional insurance mark, and insurance calculation mode.

In one possible implementation, the configuration of predefined insurance factors (which may be understood to include at least one of a kernel insurance factor, a kernel claim factor, a claim settlement factor, and a rate factor) may also be included in the displayed risk basic information configuration page to further reduce the time consuming development of the software and reduce its complexity.

Further, the present embodiment may further include step 103.

Step 103, receiving configuration information.

In this step, the server may receive configuration information corresponding to the responsibility plan configuration page sent by the terminal, so as to implement configuration of the health insurance product, where the configuration information may include configuration of insurance responsibility trees, and configuration of one insurance responsibility tree may be understood to include configuration of insurance responsibility under each level thereof, so that configuration of the insurance responsibility tree may be implemented according to the configuration information, and configuration of the health insurance product may be completed. The configuration information corresponding to the responsibility plan configuration page sent by the terminal may be at the terminal side, where the terminal receives the configuration information corresponding to the responsibility plan configuration page sent by the user and sends the configuration information to the server.

In order to further refine the responsibility, in this embodiment, the insurance responsibility configured by the configuration information may include medical service detail information for claim settlement, so that the purpose of effective fee control may be further achieved through medical service detail configuration.

In one possible implementation, the medical service details may establish a correspondence with the standard codes, which facilitates matching of the service codes provided by the medical service provider with the standard codes, and facilitating subsequent claims settlement according to the standard codes, and realizing medical fee control.

As shown in fig. 4, medical service details are configured in the preventive liability, and standard codes 00010001001, 00010001002 and 00010001003 correspond to medical service details named aspirin, antibiotic and hospitalization, respectively.

For health insurance products, the same disease may correspond to a plurality of different insurance products, and the content of the product guarantees is approximately the same. It is contemplated that the same insurance responsibilities may be included in different health insurance products and may be preconfigured to avoid inefficiency caused by repeated manual entry and storage during product configuration. Thus, when the responsibility plan is configured, the preconfigured insurance responsibility can be directly invoked.

It should be noted that, in this embodiment, a preconfigured insurance responsibility may include at least one hierarchy.

Assuming that the insurance responsibilities are preconfigured, in this step, the configuration information corresponding to the received responsibilities plan configuration page may include call information on the preconfigured insurance responsibilities and hierarchical information in the corresponding insurance responsibilities tree to efficiently implement the configuration of the insurance responsibilities.

Of course, in order to ensure the expandability of the configuration, in this step, the configuration information corresponding to the received responsibility plan configuration page may also include newly added insurance responsibility information and hierarchy information in the corresponding insurance responsibility tree.

That is, in one possible implementation, in this step, the configuration information corresponding to the received responsibility plan configuration page may further include call information on the preconfigured insurance responsibilities and hierarchy information in the corresponding insurance responsibility tree, and newly added insurance responsibility information and hierarchy information in the corresponding insurance responsibility tree.

That is, in this step, the configuration of the insurance responsibility tree included in the configuration information may include call information of the preconfigured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility.

It should be noted that, in the responsibility plan configuration page, the preconfigured insurance responsibility may be selected to perform the hierarchical configuration of the insurance responsibility, or the hierarchical configuration of the insurance responsibility may be newly added to perform the hierarchical configuration of the insurance responsibility, so that repeated jumps between pages may be reduced, which is beneficial to implementing the rapid configuration of the product.

In addition, if the responsibility plan configuration page further includes a configuration of insurance responsibility rules, the configuration information further includes a configuration of insurance responsibility rules, where one insurance responsibility rule of the configuration corresponds to at least one insurance responsibility.

If the responsibility plan configuration page also includes the configuration of the responsibility plan basic information and the configuration of the rate, the configuration information also includes the configuration of the responsibility plan basic information and the configuration of the rate.

And if at least one of the configuration of the insurance responsibility rules, the configuration of the responsibility plan basic information and the configuration of the rate in the responsibility plan configuration page includes a predefined insurance factor, in this step, the configuration information includes the configuration of the predefined insurance factor.

Of course, if the dangerous basic information configuration page is displayed when the health dangerous product configuration request is received, in this step, configuration information corresponding to the dangerous basic information configuration page may also be received. The server can receive configuration information corresponding to the dangerous seed basic information configuration page sent by the terminal so as to perfect the configuration of the health dangerous product. The configuration information corresponding to the dangerous seed basic information configuration page sent by the terminal may be that the terminal receives the configuration information corresponding to the dangerous seed basic information configuration page sent by the user and sends the configuration information to the server.

In addition, after the configuration information (the configuration information may be understood as the configuration information corresponding to the configuration page of the responsibility plan, and if the configuration information corresponding to the configuration page of the risk base information is also received, it may be understood as the configuration information corresponding to the configuration page of the responsibility plan and the configuration information corresponding to the configuration page of the risk base information) sent by the receiving terminal, the verification information corresponding to the received configuration information may be obtained by verifying the correctness of the received configuration information.

If the verification information is that the verification is passed, the received configuration information can be used as the configuration information of the health insurance product, so that the correct configuration of the health insurance product is ensured.

Of course, if the verification information is that the verification is not passed, in one possible implementation, the received configuration information may be prompted to be modified, so that the correct configuration of the health risk product may be achieved finally.

In one possible implementation, verifying the correctness of the received configuration information may include: simulating the application process and the claim settlement process of the health insurance product according to the received configuration information, and verifying the correctness of the received configuration information according to the application process and the claim settlement process.

That is, after the health risk product is configured, in order to ensure the accuracy of the configuration, in this embodiment, a product verification function may be further provided. Wherein, can simulate the application and claims process, verify the correctness of the product.

The following describes a scheme provided by the first embodiment of the present invention through the second embodiment.

Example two

The schematic diagram of the health insurance product configuration design provided in the second embodiment of the present invention may be as shown in fig. 5, where the health insurance product configuration design may be divided into three modules: the pre-definition of insurance factors (factor management), the pre-configuration of insurance responsibilities (responsibilities management) and the configuration of health insurance products (risk management, the configuration of the responsibilities plan in the health insurance product configuration is illustrated in fig. 5), respectively.

In this embodiment, factor management may be understood as predefining influencing parameters commonly used in insurance and claims to facilitate reuse of influencing parameters. When the insurance factor is predefined, the insurance factor, the claim factor and the rate factor can be defined, so that the user can directly configure the defined insurance factor when the insurance responsibility is preconfigured or the health insurance product is configured.

In this embodiment, responsibility management may be understood as managing insurance responsibility commonly used in a risk protection plan. The insurance responsibility is preconfigured, so that a user can conveniently and directly call the configured insurance responsibility to complete the hierarchical configuration of the insurance responsibility tree when the health insurance product is configured.

It should be noted that, the pre-configuring an insurance responsibility may include, but is not limited to, pre-configuring at least one of basic information of the insurance responsibility and content of the insurance responsibility. Pre-configuring an insurance responsibility can be understood as the same as configuring an insurance responsibility in real time according to a responsibility plan configuration page, and the description will not be repeated later.

Taking fig. 4 as an example, assume that three insurance responsibilities are preconfigured as preventive responsibilities, full oral examination, and full oral fluorine coating, respectively. The pre-configured insurance responsibility basic information of the preventive responsibility can include, but is not limited to, preventive responsibility with a responsibility name of 001, a responsibility code of limited times of responsibility types, and reimbursement with a reimbursement type.

The insurance liability content may include, but is not limited to, configuration of medical service details. Taking fig. 4 as an example, in the content of pre-configured preventive liabilities, standard codes are 00010001001, 00010001002 and 00010001003, corresponding to medical service details named aspirin, antibiotics and hospitalization, respectively.

Preconfigured insurance responsibilities may be invoked separately. Of course, in one possible implementation, when an insurance responsibility is preconfigured, at least one level of configuration may be made of the insurance responsibility. That is, the insurance liability content of the preconfigured insurance liability may include liability details (of course, each liability details may further include a next-level liability details), so that the preconfigured insurance liability may be recalled in a composite manner. Taking fig. 5 as an example, assuming that two insurance responsibilities are preconfigured, each preconfigured insurance responsibilities includes two levels, the insurance responsibilities of a first level may be referred to as responsibilities, and the insurance responsibilities of a second level may be referred to as liability items. Wherein, medical service detail configuration can be further carried out for each insurance responsibility (including the insurance responsibility of the first level and the insurance responsibility of the second level), and the medical service detail configuration corresponding to each responsibility insurance can be represented by a standard code.

It should be noted that the fine responsibility is also an insurance responsibility, but has a hierarchical relationship with other insurance responsibilities, and can be configured and used as an insurance responsibility alone.

It should be further noted that, in order to further save system resources and avoid repetitive work, in the case of multi-level configuration of an insurance responsibility, fine-responsibility configuration may be implemented by calling the configured insurance responsibility.

In the configuration process of health insurance products, dangerous seed basic information and responsibility plan configuration can be carried out. That is, in the present embodiment, the risk management is understood to be the management of risk information, and also includes the management of responsibility plans (i.e., products). As shown in fig. 5, in the responsibility plan configuration process, responsibility plan basic information configuration, responsibility and rule configuration, and rate configuration may be included. The responsibility and rule configuration may be understood to include configuration of insurance responsibility (such as hierarchical configuration of insurance responsibility, basic information configuration of insurance responsibility, content configuration of insurance responsibility, etc.), and configuration of insurance responsibility rules. As shown in fig. 5, a predefined maintenance factor and a claim factor may be applied to the responsibility plan basic information configuration, a predefined claim factor may be applied to the responsibility and rule configuration, and a predefined rate factor may be applied to the rate configuration. And preconfigured insurance responsibilities may be applied to responsibilities and rule configurations.

Taking fig. 6 as an example, in the health insurance product configuration process, when the responsibility plan is added, the responsibility plan basic information can be configured, wherein the configuration can be realized through the added kernel protection factors and kernel claim factors (namely, the added predefined kernel protection factors and kernel claim factors);

in adding the liability plan, an insurance liability (in fig. 6, the insurance liability is simply referred to as liability) may also be selected, wherein the selection of the insurance liability may be achieved by adding the insurance liability (i.e., adding a preconfigured insurance liability), and an insurance liability rule may be configured (which may be understood as configuring an insurance liability claim rule), wherein the configuration may be achieved by adding a claim factor (i.e., adding a predefined claim factor);

rates (configuration rate tables) may also be configured when increasing the responsibility plan, wherein the configuration may be achieved by an added rate factor (i.e., an added pre-defined rate factor).

The embodiment of the invention fully considers the unique characteristics of health risks and designs a set of health risk product configuration scheme, so that the claims can be thinned to the responsibility and responsibility fine item layers when the claims are settled, thereby achieving the purposes of fine claims settlement and cost control.

In addition, according to the scheme provided by the embodiment of the invention, due to the flexibility and adaptability of the configuration of the health insurance product, development work required before the health insurance product is on line can be reduced, and the quick on-line of the health insurance product is facilitated.

The following describes the solutions provided in the first and second embodiments of the present invention by way of a specific example.

Example III

For example, if a dangerous seed A is used, the guarantee information is shown in table 4, the rate information is shown in table 5, and the product configuration can be performed according to the health dangerous product configuration method provided by the invention.

In this embodiment, when receiving the health risk product configuration request, the terminal side may send the request to the server side. The server side may configure the page in response to the responsibility plan according to the request. The terminal side may display a responsibility plan configuration page for the server side response. The user can configure the basic information of the dangerous seed corresponding to the dangerous seed A according to the responsibility plan configuration page displayed on the terminal side, can configure two responsibility plans aiming at the dangerous seed A, respectively record as a plan 1 and a plan 2, and respectively configure insurance responsibility trees aiming at the plan 1 and the plan 2. The insurance responsibility tree corresponding to the plan 1 (the responsibility tree corresponding to the plan 2 is the same as the insurance responsibility tree corresponding to the plan 1) comprises insurance responsibility A and insurance responsibility B, and the insurance responsibility A comprises a fine responsibility item A-1, a fine responsibility item A-2 and a fine responsibility item A-3.

The constraint (insurance responsibility rule) of each insurance responsibility may be configured after the insurance responsibility tree configuration is completed. The insurance liability rules in plan 1 include: the fine liability item A-1, fine liability item A-2 and fine liability item A-3 in insurance liability A are all limited 1 time, and the sum of claims limit 3000 of insurance liability B. The insurance liability rules in plan 2 include: the fine liability item A-1, fine liability item A-2 and fine liability item A-3 in the insurance liability A are all limited to 2 times, and the sum of claims limit of the insurance liability B is 6000.

Taking the tariff table shown in table 5 as an example, gender may be selected as a transverse factor and age as a longitudinal factor to be deconfigured to achieve rate calculation based on the tariff table.

TABLE 4 product A Security schedules

TABLE 5 product A tariff

After receiving the configuration information sent by the user, the terminal side can send the configuration information to the server side, and the server side can receive the configuration information and store the configuration information, so that the configuration of the dangerous seed A is completed.

The following apparatuses and methods are provided corresponding to the methods provided in the first to third embodiments.

Example IV

A fourth embodiment of the present invention provides a health risk configuration device, where the structure of the device may be as shown in fig. 7, including:

The receiving module 11 is used for receiving a health insurance product configuration request sent by the terminal; receiving configuration information corresponding to a responsibility plan configuration page sent by the terminal;

the response module 12 is configured to respond to the responsibility plan configuration page to the terminal according to the received health insurance product configuration request, where each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure;

the configuration information received by the receiving module 11 includes configuration of the insurance responsibility tree;

the configuration of the insurance responsibility tree included in the configuration information includes calling information of preconfigured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility. In one possible implementation, each level of an insurance responsibility tree includes at least one insurance responsibility. In one possible implementation, the insurance responsibilities configured by the configuration information received by the receiving module 11 include healthcare detail information for claim settlement.

In a possible implementation manner, if the responsibility plan configuration page displayed by the response module 12 further includes configuration of insurance responsibility rules, the configuration information received by the receiving module 11 further includes configuration of insurance responsibility rules, where one insurance responsibility rule configured corresponds to at least one insurance responsibility.

In a possible implementation manner, if the responsibility plan configuration page displayed by the response module 12 further includes configuration of responsibility plan basic information and configuration of rate, the configuration information received by the receiving module 11 further includes configuration of responsibility plan basic information and configuration of rate.

In a possible implementation manner, if at least one of the configuration of the insurance responsibility rule, the configuration of the responsibility plan basic information, and the configuration of the rate included in the responsibility plan configuration page displayed by the response module 12 includes a predefined insurance factor, the configuration information received by the receiving module 11 includes a configuration of the predefined insurance factor;

In a possible implementation manner, the response module 12 is further configured to respond to the dangerous seed basic information configuration page to the terminal according to the received health insurance product configuration request;

the receiving module 11 is further configured to receive configuration information corresponding to the dangerous seed basic information configuration page sent by the terminal.

In a possible implementation manner, the receiving module 11 is further configured to obtain verification information corresponding to the received configuration information, and if the verification information is verification passing, use the received configuration information as the configuration information of the health risk product; the verification information is obtained by verifying the correctness of the received configuration information.

In one possible implementation, verifying the correctness of the received configuration information includes:

Example five

The fifth embodiment of the present invention provides a health risk product configuration method, where the embodiment uses a terminal as an execution body for illustration. The flow of the steps of the method can be as shown in fig. 8, including:

step 201, a health risk product configuration request is received.

In this step, the terminal may receive a health risk product configuration request sent by the user.

Step 202, sending the health risk product configuration request.

In this step, the terminal may send the received health risk product configuration request to the server.

Step 203, receiving and displaying a responsibility plan configuration page.

In this step, the terminal may receive and display a responsibility plan configuration page responded by the server, where each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure.

Further, the present embodiment may further include step 204.

Step 204, receiving configuration information.

In this step, the terminal may receive configuration information corresponding to a responsibility plan configuration page sent by the user, where the configuration information includes configuration of the insurance responsibility tree.

Step 205, transmitting configuration information.

In this step, the terminal may transmit the received configuration information to the server.

Corresponding to the method provided in embodiment five, the following apparatus is provided.

Example six

A sixth embodiment of the present invention provides a health risk configuration device, where the structure of the device may be as shown in fig. 9, including:

the receiving module 21 is configured to receive a health insurance product configuration request, and receive a responsibility plan configuration page responded by the server, where each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure; the sending module 22 is configured to send the health risk product configuration request to the server; the display module 23 is configured to display the responsibility plan configuration page received by the receiving module.

The receiving module 21 is further configured to receive configuration information corresponding to the responsibility plan configuration page, where the configuration information includes configuration of the insurance responsibility tree; the sending module 22 is further configured to send the configuration information to the server.

Based on the same inventive concept, embodiments of the present invention provide the following apparatuses and media.

Example seven

A seventh embodiment of the present invention provides a health risk configuration device, which may be configured as shown in fig. 10, and includes at least one processor 31; and a memory 32 communicatively coupled to the at least one processor; wherein the memory 32 stores instructions executable by the at least one processor 31 to enable the at least one processor 31 to perform the steps of the method according to one or more embodiments of the present invention.

Alternatively, the processor 31 may specifically include a Central Processing Unit (CPU), an application specific integrated circuit (ASIC, application specific integrated circuit), one or more integrated circuits for controlling program execution, a hardware circuit developed using a field programmable gate array (FPGA, field programmable gate array), and a baseband processor.

Optionally, the processor 31 may comprise at least one processing core.

Alternatively, the memory 32 may include a Read Only Memory (ROM), a random access memory (RAM, random access memory), and a disk memory. The memory 32 is used for storing data required by the operation of the at least one processor 31. The number of memories 32 may be one or more.

An eighth embodiment of the present invention provides a non-volatile computer storage medium storing an executable program, which when executed by a processor, implements the method provided in the first or fifth embodiment of the present invention.

In a specific implementation, the computer storage medium may include: a universal serial bus flash disk (USB, universal Serial Bus flash drive), a removable hard disk, a Read-Only Memory (ROM), a random access Memory (RAM, random Access Memory), a magnetic disk or an optical disk, or the like, which can store program codes.

In the embodiments of the present invention, it should be understood that the disclosed apparatus and method may be implemented in other manners. For example, the above-described embodiments of the apparatus are merely illustrative, e.g., the division of the units or units is merely a logical functional division, and there may be additional divisions when actually implemented, e.g., multiple units or components may be combined or integrated into another system, or some features may be omitted or not performed. Alternatively, the coupling or direct coupling or communication connection shown or discussed with each other may be through some interface, indirect coupling or communication connection of devices or units, electrical or otherwise.

The functional units in the embodiments of the present invention may be integrated into one processing unit, or each unit may be an independent physical module.

The integrated units, if implemented in the form of software functional units and sold or used as stand-alone products, may be stored in a computer readable storage medium. With such understanding, all or part of the technical solution of the embodiments of the present invention may be embodied in the form of a software product stored in a storage medium, including instructions for causing a computer device, which may be, for example, a personal computer, a server, or a network device, or a processor (processor), to perform all or part of the steps of the method described in the embodiments of the present invention. And the aforementioned storage medium includes: universal serial bus flash disk (universal serial bus flash drive), removable hard disk, ROM, RAM, magnetic or optical disk, or other various media capable of storing program code.

It will be appreciated by those skilled in the art that embodiments of the present invention may be provided as a method, system, or computer program product. Accordingly, the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present invention may take the form of a computer program product embodied on one or more computer-usable storage media (including, but not limited to, disk storage, CD-ROM, optical storage, and the like) having computer-usable program code embodied therein.

The present invention is described with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems) and computer program products according to embodiments of the invention. It will be understood that each flow and/or block of the flowchart illustrations and/or block diagrams, and combinations of flows and/or blocks in the flowchart illustrations and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.

These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart flow or flows and/or block diagram block or blocks.

These computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.

While preferred embodiments of the present invention have been described, additional variations and modifications in those embodiments may occur to those skilled in the art once they learn of the basic inventive concepts. It is therefore intended that the following claims be interpreted as including the preferred embodiments and all such alterations and modifications as fall within the scope of the invention.

It will be apparent to those skilled in the art that various modifications and variations can be made to the present invention without departing from the spirit or scope of the invention. Thus, it is intended that the present invention also include such modifications and alterations insofar as they come within the scope of the appended claims or the equivalents thereof.

Claims

1. A health risk product configuration method, the method comprising:

Receiving a health insurance product configuration request sent by a terminal;

the configuration of the insurance responsibility tree, which is included in the configuration information, includes calling information of preconfigured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility;

the method further comprises the steps of:

2. The method of claim 1, wherein each level of an insurance responsibility tree comprises at least one insurance responsibility.

3. The method of claim 1, wherein the configuration information is configured to include healthcare detail information for claim settlement in insurance liabilities.

4. The method of claim 1, wherein the liability plan configuration page further includes a configuration of insurance liability rules;

5. The method of claim 4, wherein the responsibility plan configuration page further includes configuration of responsibility plan basic information and configuration of rate;

6. The method of claim 5, wherein if at least one of the configuration of insurance responsibility rules, the configuration of responsibility plan basic information, and the configuration of rate included in the responsibility plan configuration page includes a predefined insurance factor, the configuration of the predefined insurance factor is included in the configuration information;

7. The method of claim 1, wherein the method further comprises:

8. A health risk product configuration device, the device comprising:

The receiving module is further configured to obtain verification information corresponding to the received configuration information, and if the verification information is verification passing, take the received configuration information as the configuration information of the health risk product; the verification information is obtained by verifying the correctness of the received configuration information.

9. A non-transitory computer storage medium storing an executable program that is executed by a processor to implement the method of any one of claims 1 to 7.

10. A health risk product configuration device, the device comprising:

at least one processor; and

a memory communicatively coupled to the at least one processor; wherein,,

the memory stores instructions executable by the at least one processor to enable the at least one processor to perform the steps of the method of any one of claims 1 to 7.