人身保險停效保單復效動機與風險之研究

Studies On The Motivation and Risk Of Reinstatement Of The Lapse Policy Of Individual Insurance.

蕭玲蓉(Ling-Jung Hsiao)

指導教授 ： 陳定國

淡江大學/管理學院/管理科學研究所企業經營碩士在職專班/碩士(2006年)

https://doi.org/10.6846/TKU.2006.00988

摘要

本文以A壽險公司個人險經審核獲准之復效保單，在回復效力一年內即發生事故，經保險公司已報已決之結案件，為研究對象。
研究的目的，在探討停效保單復效之現況；分析停效保單復效之動機；描述保單復效後短期理賠發生率及醫療給付之現象；探討保單在持續有效時，即有理賠記錄之保單，當復效後短期理賠之分析；分析同一被保險人多次理賠之現象，是否存在逆選擇情況。
研究結果發現，在事故原因分析，疾病高於意外事故；性別分析，女性疾病發生率及給付金額皆高於男性；男性意外事故發生率高於女性。在給付金額比較，復效保單高出壽險總體平均給付；理賠記錄分析，停效前曾申請過理賠之保單，復效後短期發生事故發生率及給付金額，亦高出無理賠記錄者。險種給付分析，以日額型終身醫療險最高，其次為手術醫療終身保險，第三為實支實付型，住院醫療限險。
A公司停效保單復效，理賠發生率及平均給付金額，高出整體經驗。保險公司應繼續保有核保重新審核權，重新核保確實可以防止逆選擇。但當契約在有效期間發生之疾病與事故，復效時不應以此既往症而拒絕。建議未來在修法時，應針對不同產品、險種，訂定不同審核權與定價制度。保險公司應建置核保、理賠、業務品質內控通報與獎懲機制，以防堵逆選擇。

關鍵字

停效保單 ； 復效 ； 核保 ； 理賠記錄

並列摘要

This paper is to study and analyze the early claim (within 1 year of commencement reinstatement) results of the payment of individual life insurance reinstatement polices.　
A policy lapse in force again in compliance with the reinstatement provision of the policy owner must provide evidence of insurability satisfactory to the insurance companies. After this evidence is reviewed, the underwriter can recommend one of three actions:
1. To grant reinstatement as requested.
2. To decline reinstatement if the risk has increased so much that the underwriter cannot justify allowing the person to remain in the original risk class.
3. To offer to reissue the policy at a higher premium charge.
There are five purposes of the study:
1. Discussing the lapsed policy phenomenon in Taiwan
2. Analyzing the intention to reinstate a policy.
3. Describing the early claim result.
4. Discussing the influence of claim records before lapsed.
5. Analyzing the insured apply repeat claim histories
We hope that this study could be beneficial to the government and insurance companies. The major findings of this study are as follows：
1. The female’ morbidity is higher than male after reinstatement.
2. The probability of the male suffered accident incident is higher than the female.
3. The client gained the benefit of claim has higher risk than before lapsed.
4. The policies of reinstatement has higher loss ration and payment than without lapsed policies.
To remain the right of policy owner must provide evidence of insurability satisfactory to the insurance companies that prevent the anti-selection. To permit reinstatement as requested must base on various product .

並列關鍵字

Policy Lapse ； Reinstatement ； Underwriting ； Claim Of Histories

參考文獻

3.余秀芳（2003），台灣地區病人重複住院之分析，國立台灣大學公共衛生學院衛

10. 鄭銌鋪(2004)，壽險業健康醫療險理賠預警系統之研究，臺中健康暨管理學院經營管理研究所碩士論文。

1.Brennan George (2003), Canadian Content Life Insurance Contract Provisions

And the Underwriter ALU, Volume1.。

Management Institute)。