團體保險專案商品理賠率之研究-以T保險公司為例

台灣自民國六十年推出第一張團體險保單迄今已有四十餘年。近年來團體保險發展已遭遇重大瓶頸，同業間削價競爭，導致理賠率居高不下，保險公司幾乎已無獲利空間。各保險公司為尋求有利基之業務，莫不進行市場區隔，針對小團體推出專案商品。但因專案商品具有統一銷售、費率一致、核保簡單化（大多為免填寫健康告知）等條件，是否將吸引高風險之要保單位投保，導致理賠率提高，或因健康告知條件不同，吸引高風險團體選擇免健康告知，導致理賠率提高，則值得研究。本研究係以國內一家T保險公司所承保專案件團體保險為研究對象，透過分析統計，探討要保單位投保狀況，希望透過此一研究，了解專案商品經營之風險，提出可能的因應對策與建議，使團體保險專案商品可以獲得良性運作與發展。經本研究發現，專案件並未明顯吸引高職業別團體加保，導致理賠率提高。由專案件之理賠經驗分析，其意外險之理賠率介於33%~51%，顯示雖然專案件之訂價採不同職業類別但以單一費率承保，並未明顯的吸引較高職業類別之團體（個人），為了享有較低的意外險費率而選擇加入，造成定價上的逆選擇清況發生，反而因為投保母體的增加，平均了專案件的職業類別風險；但健康告知條件不同，確實會吸引高風險團體選擇免健康告知之專案加保，導致理賠率提高之情況發生。雖然因為國內團險市場的過度競爭下，導致經營大型客戶團體保險幾無利潤，而專案件的團險提供了團體保險一項利基業務的來源，不過保險公司仍應請各相關部門擬妥適當因應策略，以防止逆選擇的產生，同時增加保險公司的利基業務。

關鍵字

團體保險；專案商品；理賠率；逆選擇

並列摘要

In 1971, Taiwan launched the first group insurance policies so far. . In recent years, the evelopment of group insurance has limited due to price competition, which has led to high odds and there is no profit for insurance company. Because of this, the insurance companies looking for the method to increase profit. Each insurance company is seeking a niche business, market segmentation, and launching products for specific groups. These products have single sale channel, consistent rates, simple requirements (no need a health announce) and son on…. , may attract high-risk insurance protection units, this will result in higher compensation rate. Because the high-risk groups are choosing free health advice, may cause higher compensation rate, this is case worth further study. This study is based on the project products of T insurance company. Through statistical analysis, to understand the status of these insured units and profit and loss condition . It is also hoped that there will be a better understanding of the risks of the project commodity operations, and provide suggestions and countermeasures can be made so that goods can be better obtained through ad hoc group insurance. This will also encourage better operation and development. The study found that project products do not attract high-risk insurant and also don’t increase compensation ratio. Analysis of the claims cases showed the accident odds ranging from 33% to 51%, did not found the high risk insurant who want pay lower accident insurance price . Actual more insured population will reduce the risk of profession category risk of project products. Different health announce condition , will attract high risk group to choose that don't need health announce of the project products. this will cause high compensation ratio, and cause the risk of adverse selection. Insurance company need find out the solution to prevent this then keep the profit.

並列關鍵字

group insurance ； project products ； compensation ratio ； adverse selection

參考文獻

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2.Browne, M. J., 1992, Evidence of Adverse Selection in the Individual Health Insurance Market, Journal of Risk and Insurance, 59: 13-33.

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團體保險專案商品理賠率之研究-以T保險公司為例

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