中国寿险公司团体保险经营中面对的风险及其对策

【作者】 黄陶；

【导师】 卓志；

【作者基本信息】 西南财经大学 ， 工商管理， 2009， 硕士

【摘要】 发达国家的经验表明,团体保险已成为现代员工福利计划的最重要的保障方式之一。团体保险以团体为投保人,用同一张保单承保多个成员的风险,具有投保成本低、管理简便,能够部分消除逆向选择等特点,从而在成本上具有规模经济效益,因此在高速发展的我国极具前景。但目前我国团体保险在市场发展过程中的违规问题十分突出,经营中的风险已经成为了阻碍团体保险发展的主要因素,加之国内保险公司长期以来的重视个险发展,忽视团险发展的经营行为,使得团体保险业务在寿险保费中的占比逐年下滑。经营中的风险是制约团体保险发展的关键,本文基于这样的情况,对团体保险在经营中的风险进行分析和研究,同时提出解决风险问题的建议,希望能够对国内的寿险公司发展团体保险提供帮助。全文分为四章:第一章通过介绍团体保险经营及其发展状况,引出了团体保险稳健发展的重要性:1、团体养老保险可为企业建立补充养老保险制度,以解决员工退休收入问题;2、团体医疗费用保险可为企业员工解决因病或意外导致的住院或门诊医疗费用支出;3、团体医疗津贴保险可为员工提供适当的住院或手术津贴,既可用于国家公费或劳保医疗制度中不予负担的医药、医疗检查或特别护理等项目的支出,提高员工的医疗质量,又可补贴员工因病导致的收入减入;4、团体人身意外伤害保险或团体定期寿险,可为在雇佣期间因意外或疾病导致死亡时的员工家属提供抚恤金或抚养费;5、失能保险,可为在雇佣期间因意外或疾病导致残废而丧失工作能力时的员工提供收入补偿。第二章是提出问题的部分,首先是团体保险内外部风险的阐述,然后将团体保险分成了团体养老保险、团体健康险和团体意外险三类,分别对三类产品所面临的主要风险问题进行了分析和阐述。团体养老保险主要面临的是违规处理退保金,长险短做,团单个做等监管风险,其中违规处理退保金的行为还违反了“反洗钱”法的有关规定;团体健康险主要面临的是因业务经营不善所带来的亏损风险,正是由于这个风险的存在,使得保险公司近几年的健康险业务大量萎缩,也是许多新筹建的保险公司不将其纳入重点业务开拓的主要原因;团体意外保险主要面临的是高收费和佣金的违规处理和某些极短期业务中因销售流程的漏洞所带来的业务风险。针对第二章的风险问题,第三章仍然按照内外部风险成因和三类险种的划分对风险的成因进行了分析。团体养老保险的风险问题主要是由于传统的养老险市场受到冲击,需求下降,导致了最终的业务变形,因此产生了上述的风险问题;团体健康险主要是由于保险公司的考核导向,风险控制流程等方面不够完善所导致,同时也受到了竞争、市场发展不完善等因素的影响;团体意外险主要是受竞争的影响导致的业务获取成本提高,另外跟违规行为不易被查出等因素有关。第四章是本文的重点章节,针对各类险种的风险成因提出了解决措施和思路,团体养老保险着重于政策和保险公司经营思路的调整方面;团体健康险着眼于保险公司自身的问题,提出了从客户选择、风险评估到理赔控制的一整套措施和建议;团体意外险则是通过全面的系统化操作和管理从根本上杜绝花样繁多的违规行为。本文第四章是提出解决措施的环节,基于对风险成因的分析和一些理论知识,在对于政府的政策推动和保险公司一些内部制度的调整方面提出了一些创新性的想法;同时不足之处在于,团体保险所面临的风险是一个相对复杂的问题,很多风险之间既有个性也有共性,本文针对不同的团体产品类别对其主要的风险问题进行了分析和研究,并未涵盖团险经营中的所有风险。更多还原

【Abstract】 The existing experience in developed countries has proved that group insurance has become currently the most effective way to realize the welfare plan of modern employees. It targets at a group , underwriting insurantial security of several individuals within a single contract, which has lowered the insurance cost, smoothed the management and partly diminished the risk of choosing backward. It has a promising future in a high-speed developing country like china regarding its mass economic profit. However in China, the group insurance market has prominent problems of infringement and violations of the rules, which impedes its further development. Plus the domestic insurance companies have been since long time ago focusing on personal insurance, the share of the group insurance plunges quickly each year. Operating constraints of the risk is the key to a healthy development of group insurance. This article is to investigate and analyze risk management in group insurance and try to come up with suggestive solutions. At the same time, it aims to help domestic insurance companies within the corresponding respective.Chapter one elucidates the importance of developing Group Insurance by covering following aspects: 1. The Group Endowment Insurance could help enterprises construct a supplementary endowment insurance system to solve the pension problem 2. The Group Medical Insurance could help employees alleviate the burden of medical cost; 3. The Group Insurance of supplementary allowance for medical cost could provide additional financial help. It reimburses the cost of medicines, check-outs and special cares which could not be covered by governmental aid or social insurance. It not only improves medical care of the employees but also covers compensation caused by their absence from work; 4. The Group Unexpected Injury Insurance or the Group Life Insurance could provide compensation for relatives of employees who die of accidents or diseases; 5. The group Disabled Insurance could provide compensation for employees who are disabled or lost their working ability caused by accidents or diseases.The second chapter has provided the problem which this article will solve afterward. Firstly, it described the inside and outside risks of group insurance. Then , it divided group insurance into three sub-categories: group endowment insurance, group health insurance and group accident insurance and also analyzes and explains the major risks which these three categories respectively face. Group endowment insurance faces risks such as illegal handling of payback money, which also violates anti-money-laundry regulation, improper control over immediate realization of a long-term insurance or individual compensation out of a group contract. Group health insurance faces main risk of business losses caused by poor management. It is precisely because the existence of such risk, the insurance companies’ health insurance business has shrunk drastically in recent years. It also becomes the reason why many new insurance companies are not willing to expand such business. Group accident insurance faces how to deal with abnormal high charges and commissions and risks in short-term business caused by loopholes during sales.In connection with the issue of risk addressed in the second chapter, the third chapter continues to analyze its formations in accordance with the inside and outside risk and the three categories of insurance. The risk of group pension insurance lies in the fact that, due to the negative impact on the traditional pension insurance market, there is a decline of demand, causing the deterioration of its business and thus the risks mentioned above. As for the group health insurance, its risks are mainly caused by the defects of its risk control process, which in turn is caused by the performance-oriented evaluation approach, and it is also subject to the influence of such factors as competition and immaturity of market development. With regard to group accident insurance, the risk is mainly accounted to the increasing cost of winning clients led by competition as well as the difficulty of identifying fraud behaviors.Chapter IV is the center of this article, which provides solutions for various types of insurance risks. Group pension insurance focuses on the adjustment between policy and strategy of insurance companies while Group health insurance focuses on their inner problems. A set of measures and proposals are brought forward from Choice of Customers, Risk Assessment to Claims Control. Group accident insurance exploits a comprehensive systematic operation and management to put an end to various sorts of violations.The solutions that chapterⅣhas come up with are a number of innovative ideas based on analysis of the causes of insurance risk and relative theoretical knowledge regarding the policy of the government and insurance companies to promote some internal system adjustment. At the same time, there are still questions left to be discussed. Group insurance risks are a relatively complex issue, a lot of risk between the personalities both have in common. This paper focuses on the main risks of different group insurance sub-categories, without covering a very comprehensive analysis on various types of risks in operating practice.更多还原