TW201913519A - Blockchain-based insurance service method and system having an insurance-end system and a hospital-end system both connected to the blockchain - Google Patents
Blockchain-based insurance service method and system having an insurance-end system and a hospital-end system both connected to the blockchain Download PDFInfo
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本發明是有關於一種保險服務方法與系統，特別是指一種基於區塊鏈的保險服務方法與系統。The invention relates to an insurance service method and system, in particular to an insurance service method and system based on blockchain.
現行保險公司針對保戶的理賠方式的流程依序如下：(1)申請：保戶本人或委託經手人攜帶理賠申請文件至保險公司的服務窗口提出理賠申請；(2)受理：服務中心的人員將保戶的理賠申請文件資料輸入系統而產生理賠件；(3)核賠：案件依照分派規則派送至保險公司的相關行政單位，由理賠人員進行理賠件的核賠；及(4)給付：保險公司針對需給付之理賠件，經由財會系統進行付款。The process of the current insurance company's claims settlement method for insurers is as follows: (1) Application: The insurer or the entrusted person shall bring the claim application document to the insurance company's service window to file a claim application; (2) Acceptance: personnel of the service center Enter the insurer's claims application documents into the system to generate claims; (3) Claims: the case is dispatched to the relevant administrative unit of the insurance company, and the claimant will verify the claims; and (4) pay: The insurance company pays for the claims to be paid through the accounting system.
然而，上述現行的理賠方式有以下缺點：(i)若理賠的申請與醫療有關，保戶需先準備診斷書紙本、收據紙本等文件資料，並由保戶本人或委託經手人將該等文件資料遞交保險公司；(ii)若在核賠的過程中保險公司需要向醫院調閱保戶的病歷，需額外花費文件往返的等待時間。因此，現行保險理賠方式的效率有待改善。However, the above-mentioned current claims method has the following disadvantages: (i) If the claim application is related to medical treatment, the insured shall first prepare documents such as the medical diagnosis paper and the receipt paper, and the insured person or the entrusted agent shall apply Wait for the documents and documents to be submitted to the insurance company; (ii) If the insurance company needs to consult the insurer ’s medical records with the hospital during the claim process, it will take extra waiting time for the documents. Therefore, the efficiency of the current insurance claims method needs to be improved.
因此，本發明之目的，即在提供一種具有高效率的基於區塊鏈的保險服務方法。Therefore, the purpose of the present invention is to provide a blockchain-based insurance service method with high efficiency.
於是，本發明基於區塊鏈的保險服務方法，用於相關於一保戶的一保單的保險服務，並由一保險業端系統實施，該保險業端系統與一醫院端系統均聯結該區塊鏈，且該醫院端系統儲存有相關於該保戶的一醫療資料，該基於區塊鏈的保險服務方法包含一步驟(a)、一步驟(b)及一步驟(c)。Therefore, the present invention is based on the blockchain-based insurance service method, which is used for insurance services related to a policy of an insured customer, and is implemented by an insurance industry-side system, the insurance industry-side system and a hospital-side system are connected to the area Block chain, and the hospital end system stores a medical data related to the insured, the block chain-based insurance service method includes a step (a), a step (b) and a step (c).
該步驟(a)是該保險業端系統從該區塊鏈接收由該醫院端系統所寫入該區塊鏈的該醫療資料。The step (a) is that the insurance end system receives the medical data written in the blockchain by the hospital end system from the blockchain.
該步驟(b)是該保險業端系統根據該醫療資料產生一對應該醫療資料的理賠資料。The step (b) is that the insurance industry end system generates a pair of claim data corresponding to the medical data according to the medical data.
該步驟(c)是該保險業端系統將該理賠資料寫入該區塊鏈。The step (c) is that the insurance industry end system writes the claim information to the blockchain.
此外，本發明之另一目的，即在提供一種具有高效率的基於區塊鏈的保險服務系統。In addition, another object of the present invention is to provide a high-efficiency insurance service system based on blockchain.
該保險服務系統包含一醫院端系統與一保險業端系統。The insurance service system includes a hospital end system and an insurance industry end system.
該醫院端系統儲存有相關於該保戶的一醫療資料，並聯結一區塊鏈，且將該醫療資料寫入該區塊鏈。The hospital end system stores a medical data related to the insured person, connects a blockchain in parallel, and writes the medical data into the blockchain.
該保險業端系統聯結該區塊鏈，並從該區塊鏈接收該醫療資料，並根據該醫療資料產生一對應該醫療資料的理賠資料，且將該理賠資料寫入該區塊鏈。The insurance industry end system links the blockchain, receives the medical data from the blockchain, generates a pair of claim data corresponding to the medical data based on the medical data, and writes the claim data into the blockchain.
本發明之功效在於：能提高保險公司的理賠效率，並縮短保險公司進行核賠所需耗費的時間與保戶等待理賠給付金的時間。The effect of the present invention lies in that it can improve the efficiency of claims settlement of insurance companies, and shorten the time required for insurance companies to make claims and the time for insurance customers to wait for payment of claims.
參閱圖1，本發明基於區塊鏈的保險服務方法，用於相關於一保戶的一保單的保險服務，並由聯結至一區塊鏈(圖未繪示)的一保險業端系統1、一醫院端系統2與一銀行端系統3實施。該區塊鏈(blockchain)儲存有一對應本發明保險服務方法的智能合約(smart contract)。該保險業端系統1由該保單所屬的一保險公司管理，該醫院端系統2由一醫療院所管理，且該銀行端系統3由一銀行業者管理。Referring to FIG. 1, the present invention is based on a blockchain-based insurance service method, which is used for insurance services related to a policy of an insured customer, and is connected to an insurance industry end system 1 connected to a blockchain (not shown) 1. A hospital end system 2 and a bank end system 3 are implemented. The blockchain stores a smart contract corresponding to the insurance service method of the present invention. The insurance system 1 is managed by an insurance company to which the policy belongs, the hospital system 2 is managed by a medical institution, and the bank system 3 is managed by a banker.
本發明基於區塊鏈的保險服務方法的一實施方式包含一住院前階段、一住院階段、一出院階段與一核賠給付階段，每一階段均對應至少一步驟流程，以下詳述之。An embodiment of the blockchain-based insurance service method of the present invention includes a pre-hospitalization stage, an in-hospitalization stage, a discharge stage, and a claims payment stage, each stage corresponding to at least one step process, which is described in detail below.
參閱圖2，在該住院前階段，該保險公司的人員取得該保戶所簽署的一醫療費用折抵同意書，然後該保險業端系統1經由該保險公司的人員的操作而產生一對應該醫療費用折抵同意書的同意費用折抵資料(S11)；接著，該保險業端系統1將該同意費用折抵資料寫入該區塊鏈(S12)，以致該區塊鏈儲存該同意費用折抵資料(S13)。特別地，經由前述步驟S11~S13，該保戶同意使用該保單的理賠金來抵繳醫療費用的相關資訊已經儲存於該區塊鏈中。Referring to FIG. 2, in the pre-hospitalization stage, the personnel of the insurance company obtains a medical expense deduction agreement signed by the insured, and then the insurance industry-side system 1 generates a pair of responses through the operation of the insurance company ’s personnel Medical expenses deduction consent data of consent fee (S11); then, the insurance system 1 writes the agreement fee deduction data into the blockchain (S12), so that the blockchain stores the consent fee Credit information (S13). In particular, through the aforementioned steps S11 ~ S13, the insured agrees to use the policy's claims to offset medical expenses. The relevant information has been stored in the blockchain.
參閱圖3，在該住院階段，該保戶辦理住院手續之後，該醫院端系統2經由該醫療院所的人員的操作而查詢該區塊鏈(S21)，以致該區塊鏈回傳該同意費用折抵資料給該醫院端系統2(S22)。接著，該醫療院所的人員取得該保戶所簽署的一電子醫療資訊傳送同意書，然後該醫院端系統2經由該醫療院所的人員的操作而將一相關於該保戶的保戶住院資料寫入該區塊鏈(S23)，以致該區塊鏈儲存該保戶住院資料(S24)，並根據該智能合約傳送一相關於該保戶的住院通知訊息給該保險業端系統1(S25)，如此該保險公司能即時獲知該保戶已經住院的訊息，並指派相關的服務人員進行保戶關懷。Referring to FIG. 3, in the hospitalization stage, after the insured person goes through the hospitalization procedures, the hospital-side system 2 queries the blockchain through the operation of the personnel of the medical institution (S21), so that the blockchain returns the consent The cost credit information is given to the hospital end system 2 (S22). Next, the personnel of the medical institution obtains an electronic medical information transmission consent signed by the insured, and then the hospital-side system 2 injects an insured related to the insured through the operation of the personnel of the medical institution The data is written into the blockchain (S23), so that the blockchain stores the insured's hospitalization data (S24), and transmits a hospitalization notification message related to the insured to the insurance system 1 according to the smart contract ( S25), so that the insurance company can immediately receive the information that the insured has been hospitalized, and assign relevant service personnel to take care of the insured.
參閱圖4，在該出院階段的出院前一日，該醫院端系統2經由該醫療院所的人員的操作而將一相關於該保戶的醫療資料寫入該區塊鏈(S31)，以致該區塊鏈儲存該醫療資料(S32)，並根據該智能合約傳送一相關於該保戶的出院通知訊息給該保險業端系統1(S33)，其中該醫療資料包含診斷書、醫療費用的明細等。接著，該保險業端系統1查詢該區塊鏈而從該區塊鏈接收該醫療資料並根據該醫療資料與該保單產生一對應的理賠件(S34)，且計算出一醫療可折抵金額(S35)，並將該醫療可折抵金額與一對應該理賠件的理賠進度資料寫入該區塊鏈(S36)，以致該區塊鏈儲存該醫療可折抵金額與該理賠進度資料(S37)。在此，該醫療可折抵金額不大於該保單的理賠金，且為該保險公司所同意的由該保單的理賠金來抵繳醫療費用的金額。Referring to FIG. 4, on the day before discharge from the discharge stage, the hospital-side system 2 writes a medical data related to the insured person into the blockchain through the operation of the personnel of the medical institution (S31), so that The blockchain stores the medical data (S32), and sends a discharge notification message related to the insured to the insurance system 1 (S33) according to the smart contract, where the medical data includes a medical certificate and medical expenses Details etc. Next, the insurance system 1 queries the blockchain and receives the medical data from the blockchain and generates a corresponding claim based on the medical data and the policy (S34), and calculates a medical deductible amount (S35), and write the medical deductible amount and a pair of claim progress data that should be claimed into the blockchain (S36), so that the blockchain stores the medical deductible amount and the claim progress data ( S37). Here, the medical deductible amount is not greater than the policy's claim, and is the amount agreed by the insurance company to cover the medical expenses from the policy's claim.
參閱圖5，在該出院階段的出院當日，該保戶臨櫃辦理出院手續，該醫院端系統2經由該醫療院所的人員的操作而查詢該區塊鏈(S41)，以致該區塊鏈回傳該醫療可折抵金額給該醫院端系統2(S42)。接著，該醫院端系統2根據該保戶的總醫療費用與該醫療可折抵金額計算出一實際折抵金額，其中若該總醫療費用高於該醫療可折抵金額，則該實際折抵金額為該醫療可折抵金額，否則該實際折抵金額為該總醫療費用(S43)。接著，該醫院端系統2將該總醫療費用與該實際折抵金額寫入該區塊鏈(S44)，以致該區塊鏈儲存該總醫療費用與該實際折抵金額(S45)，並根據該智能合約將該實際折抵金額傳送給該保險業端系統1(S46)。接著，該保險業端系統1傳送一記錄有該實際折抵金額與該醫療院所的銀行帳號的撥款通知訊息給該銀行端系統3(S47)，以致該銀行端系統3將額度為該實際折抵金額的帳款轉入該醫療院所的銀行帳號(S48)。此外，值得一提的是，當該總醫療費用高於該醫療可折抵金額時，須由該保戶臨櫃繳交該總醫療費與該醫療可折抵金額的差額。Referring to FIG. 5, on the day of discharge at the discharge stage, the insured person goes through the discharge procedures at the counter, and the hospital-side system 2 queries the blockchain through the operation of the medical institution's personnel (S41), so that the blockchain Return the medical deductible amount to the hospital system 2 (S42). Next, the hospital end system 2 calculates an actual discount amount based on the insured's total medical expenses and the medical deductible amount, where if the total medical expense is higher than the medical deductible amount, the actual discount The amount is the deductible amount of the medical treatment, otherwise the actual deduction amount is the total medical expenses (S43). Then, the hospital-side system 2 writes the total medical cost and the actual credit amount into the blockchain (S44), so that the blockchain stores the total medical cost and the actual credit amount (S45), and according to The smart contract transmits the actual credit amount to the insurance system 1 (S46). Next, the insurance-end system 1 sends an appropriation notification message that records the actual credit amount and the bank account number of the medical institution to the bank-end system 3 (S47), so that the bank-end system 3 sets the amount as the actual The account of the deducted amount is transferred to the bank account of the medical institution (S48). In addition, it is worth mentioning that when the total medical cost is higher than the medical credit amount, the insurer must pay the difference between the total medical cost and the medical credit amount.
參閱圖6，在該核賠給付階段，該保險公司的人員取得該保戶所簽署的一調閱電子病歷同意書，該保險業端系統1經由該保險公司的人員的操作而產生一對應該調閱電子病歷同意書的同意調閱電子病歷資料，並將該同意調閱電子病歷資料寫入該區塊鏈(S51)，以致該區塊鏈儲存該同意調閱電子病歷資料(S52)。接著，該區塊鏈根據該智能合約傳送一對應該同意調閱電子病歷資料的通知訊息給該醫院端系統2(S53)，以致該醫院端系統2將該保戶的電子病歷寫入該區塊鏈(S54)。接著，該區塊鏈根據該智能合約將該電子病歷傳送給該保險業端系統1(S55)；如此，該保險公司的核賠人員在理賠過程中可透過該區塊鏈取得該保戶在該醫療院所的電子病歷，免除向醫院調閱電子病歷而需耗費的人工處理與文件往返的等待時間。接著，該保險業端系統1經由該保險公司的人員的操作而查詢該區塊鏈(S56)，以致該區塊鏈回傳該實際折抵金額給該保險業端系統1(S57)。接著，該保險業端系統1判斷該保單的理賠金是否高於該實際折抵金額(S58)，當判斷出該保單的理賠金高於該實際折抵金額時，該保險業端系統1傳送一記錄有一給付金額與該保戶的一銀行帳號的通知訊息給該銀行端系統3(S59)，其中該理賠金為該給付金額與該實際折抵金額的總和。接著，該銀行端系統3將額度為該給付金額的帳款轉入該保戶的該銀行帳號(S510)，並將一對應的匯款記錄寫入該區塊鏈(S511)，以致該區塊鏈儲存該匯款記錄。Referring to FIG. 6, at the stage of payment of claims, the personnel of the insurance company obtains a written electronic medical record consent signed by the insurer. The insurance system 1 generates a pair of responses through the operation of the personnel of the insurance company. The consent to read the electronic medical record consent form reads the electronic medical record data, and writes the consent to read the electronic medical record data into the blockchain (S51), so that the blockchain stores the consent to access the electronic medical record data (S52). Then, according to the smart contract, the blockchain sends a pair of notification messages that should agree to access the electronic medical record data to the hospital-side system 2 (S53), so that the hospital-side system 2 writes the insured's electronic medical records to the area Blockchain (S54). Then, the blockchain transfers the electronic medical record to the insurance system 1 according to the smart contract (S55); in this way, the claimant of the insurance company can obtain the insured person through the blockchain during the claim process. The electronic medical record of the medical institution eliminates the waiting time for manual processing and document round trips that are required to retrieve the electronic medical record from the hospital. Next, the insurance system 1 queries the blockchain through the operations of the insurance company's personnel (S56), so that the blockchain returns the actual credit to the insurance system 1 (S57). Next, the insurance-end system 1 determines whether the policy's claim is higher than the actual discount amount (S58). When it is determined that the policy's claim is higher than the actual discount, the insurance-end system 1 transmits A record has a notification message of the payment amount and a bank account number of the insured to the bank system 3 (S59), where the claim is the sum of the payment amount and the actual credit amount. Then, the bank-side system 3 transfers the account with the payment amount to the bank account number of the insured (S510), and writes a corresponding remittance record into the blockchain (S511), so that the block The chain stores the remittance record.
此外，值得一提的是，往後該保戶可操作一電腦裝置網路連線至該保險業端系統1，並進一步透過該保險業端系統1查詢記錄於該區塊鏈的該保戶的相關資訊，例如電子病歷、匯款記錄等等。In addition, it is worth mentioning that in the future, the insured can operate a computer device network to connect to the insurance system 1 and further inquire the insured recorded in the blockchain through the insurance system 1 Related information, such as electronic medical records, remittance records, etc.
此外，值得一提的是，除了透過圖4所示的在該出院階段的出院前一日的步驟流程來自動產生該理賠件之外，在另一實施方式中，該保戶也可在出院後透過該保險業端系統1自主申請理賠。詳言之，該保險公司的人員取得該保戶所簽署的一醫療資訊傳輸同意書，然後該保險業端系統1經由該保險公司的人員的操作而產生一對應該醫療資訊傳輸同意書的同意調閱醫療資訊資料；接著，該保險業端系統1將該同意調閱醫療資訊資料寫入該區塊鏈，以致該區塊鏈儲存該同意調閱醫療資訊資料。接著，該區塊鏈根據該智能合約傳送一對應該同意調閱醫療資訊資料的通知訊息給該醫院端系統2，以致該醫院端系統2將該保戶的醫療資料寫入該區塊鏈，其中該醫療資料包含該保戶的電子病歷、診斷書、醫療費用的明細等等。接著，該區塊鏈根據該智能合約將該醫療資料傳送給該保險業端系統1，以致該保險業端系統1根據該醫療資料與該保單產生一對應的理賠件。In addition, it is worth mentioning that, in addition to automatically generating the claim through the step flow shown in FIG. 4 on the day before discharge from the discharge stage, in another embodiment, the insured may also be discharged from the hospital Later, through the insurance industry system 1 to apply for claims independently. In detail, the personnel of the insurance company obtains a medical information transmission consent signed by the insured, and then the insurance industry-side system 1 generates a pair of consents corresponding to the medical information transmission consent through the operation of the insurance company's personnel Call medical information data; then, the insurance system 1 writes the consent medical information data into the blockchain, so that the blockchain stores the consent medical information data. Then, the blockchain sends a pair of notification messages that should agree to access medical information data to the hospital-side system 2 according to the smart contract, so that the hospital-side system 2 writes the medical data of the insured person to the blockchain, The medical information includes the insured's electronic medical records, medical certificate, details of medical expenses, etc. Then, the blockchain transmits the medical data to the insurance system 1 according to the smart contract, so that the insurance system 1 generates a corresponding claim according to the medical data and the policy.
此外，值得一提的是，若有保險監理的需求，該區塊鏈還可被一對應一保險監理機構的電腦系統聯結，該保險監理機構的人員可透過該電腦系統查詢前述該區塊鏈所儲存的資訊，例如該醫療費用折抵同意書、該調閱電子病歷同意書等。In addition, it is worth mentioning that if there is a demand for insurance supervision, the blockchain can also be linked by a computer system corresponding to an insurance supervision institution, and personnel of the insurance supervision institution can query the aforementioned blockchain through the computer system The stored information, such as the medical cost deduction consent form, the electronic medical record consent form, etc.
綜上所述，本發明基於區塊鏈的保險服務方法，藉由該醫院端系統將該保戶的醫療診斷與費用資料寫入該區塊鏈，且該保險業端系統從該區塊鏈接收前述醫療診斷與費用資料，並據以產生對應的理賠件與進行核賠給付，能提高保險公司的理賠效率，並縮短保險公司進行核賠所需耗費的時間與保戶等待理賠給付金的時間，故確實能達成本發明的目的。In summary, the insurance service method based on the blockchain of the present invention writes the medical diagnosis and expense data of the insured to the blockchain through the hospital-side system, and the insurance industry-side system removes the blockchain from the blockchain Receiving the aforementioned medical diagnosis and expense data, and generating corresponding claims and payment claims accordingly, can improve the efficiency of the insurance company ’s claims, and shorten the time required for insurance companies to make claims and the insurers ’waiting for claims payment Time, it can indeed achieve the purpose of cost invention.
惟以上所述者，僅為本發明之實施例而已，當不能以此限定本發明實施之範圍，凡是依本發明申請專利範圍及專利說明書內容所作之簡單的等效變化與修飾，皆仍屬本發明專利涵蓋之範圍內。However, the above are only examples of the present invention, and should not be used to limit the scope of implementation of the present invention, any simple equivalent changes and modifications made according to the scope of the patent application of the present invention and the content of the patent specification are still considered as Within the scope of the invention patent.
1‧‧‧保險業端系統1‧‧‧ Insurance system
2‧‧‧醫院端系統2‧‧‧Hospital end system
3‧‧‧銀行端系統3‧‧‧Bank system
S11~S13‧‧‧步驟S11 ~ S13‧‧‧Step
S21~S25‧‧‧步驟S21 ~ S25‧‧‧Step
S31~S37‧‧‧步驟S31 ~ S37‧‧‧Step
S41~S48‧‧‧步驟S41 ~ S48‧‧‧Step
S51~S511‧‧‧步驟 S51 ~ S511‧‧‧Step
本發明的其他的特徵及功效，將於參照圖式的實施方式中清楚地呈現，其中： 圖1是一方塊圖，說明實施本發明基於區塊鏈的保險服務方法的系統； 圖2是一流程圖，說明該保險服務方法的一住院前階段； 圖3是一流程圖，說明該保險服務方法的一住院階段； 圖4是一流程圖，說明該保險服務方法的一出院階段的出院前一日； 圖5是一流程圖，說明該保險服務方法的該出院階段的出院當日；及 圖6是一流程圖，說明該保險服務方法的一核賠給付階段。Other features and functions of the present invention will be clearly presented in the embodiment with reference to the drawings, in which: FIG. 1 is a block diagram illustrating a system for implementing the blockchain-based insurance service method of the present invention; FIG. 2 is a Flow chart illustrating a pre-hospital stage of the insurance service method; Figure 3 is a flow chart illustrating a hospitalization stage of the insurance service method; Figure 4 is a flow chart illustrating the pre-discharge stage of the insurance service method One day; FIG. 5 is a flowchart illustrating the discharge day of the discharge stage of the insurance service method; and FIG. 6 is a flowchart illustrating a verification payment stage of the insurance service method.
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| TWI820360B (en) * | 2020-11-26 | 2023-11-01 | 陳哲斌 | Community risk mutual aid system and server thereof |
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| TWI820360B (en) * | 2020-11-26 | 2023-11-01 | 陳哲斌 | Community risk mutual aid system and server thereof |
| TWI785614B (en) * | 2021-05-18 | 2022-12-01 | 陳彥良 | Automatic chain-up system and its application method in digital certificate storage |
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