政大機構典藏-National Chengchi University Institutional Repository(NCCUR):Item 140.119/30663
English  |  正體中文  |  简体中文  |  Post-Print筆數 : 27 |  Items with full text/Total items : 113822/144841 (79%)
Visitors : 51789461      Online Users : 523
RC Version 6.0 © Powered By DSPACE, MIT. Enhanced by NTU Library IR team.
Scope Tips:
  • please add "double quotation mark" for query phrases to get precise results
  • please goto advance search for comprehansive author search
    •  Adv. Search
    Home ‧ Login ‧ Upload ‧ Help ‧ About ‧ Administer Goto mobile version


    Please use this identifier to cite or link to this item: https://nccur.lib.nccu.edu.tw/handle/140.119/30663


    Title: 產物保險業經營傷害險個案分析
    A case study on personal accident insurance operation of a non-life insurance company in Taiwan
    Authors: 廖舷安
    Liao,Hsuan An
    Contributors: 蔡政憲
    廖舷安
    Liao,Hsuan An
    Keywords: 個人傷害保險
    綜合率
    非比率再保險
    Personal accident insurance
    Combined ratio
    Excess of loss
    Date: 2006
    Issue Date: 2009-09-12 12:37:10 (UTC+8)
    Abstract: 國內保險經營，長久以來即是人身保險及財產保險分業經營方式，但兩者的經營規模差距很大，據統計資料顯示，壽險業這五年來的傷害險保費收入，平均每年約有580億元，健康險平均年約1260億元，對於產險業整體業界總保費收入約1100億元的市場規模而言，實在是塊誘人和商機無限的新市場，能加入傷害險或健康險的經營，將是產險業者突破經營瓶頸的關鍵，不僅保險市場會產生蛻變，更會對消費大眾帶來多元的選擇與影響。

    在此背景下，本研究主要探討產險業經營傷害險的績效，並舉個案實例經營此單一險種的過程，就其在商品研發、行銷、核保和理賠等各項作業流程，進行探討分析。經本研究個案分析，歸納出幾點問題，一是在經營策略面，以業績成長為首要的考量，自然會選擇通路商的行銷方式，所謂「掌握通路，就是贏家」，兩年來通路業績佔了該險種的73%，而其賠款金額佔率，亦佔了76%左右，經營績效的結果顯示出「成也通路，敗也通路」，如何強化通路商之管理是經營重點。二是由理賠資料分析統計，並與壽險業資料比較，發現有相關性趨勢，但卻有相對惡化的現象，諸如平均死亡率，男性比女性多出5倍以上，比壽險業的3倍高；平均每件死亡賠款230萬元，比壽險業的120萬元，高出近一倍，且又以男性50~59歲的年齡層最高，此點顯示出其商品是否有「保費太低而保障過高」的問題。三是其面臨人力和經驗不足的問題，加上缺乏醫療、法務、徵信調查等相關專業人員及其運作經驗，無法在核保和理賠作業時，因應實際的作業需求。

    我國保險法經過兩次修正後，現在已開放產險業者得以經營傷害險，再者，有關健康險是否可進一步開放予產險業者經營，相信很快會經立法院通過修法審議。故本研究的結果，即是找出經營問題和原因，並提出改善建議，期能提供產險業者經營傷害險或未來健康險的參酌。

    關鍵字：個人傷害保險、綜合率、非比率再保險
    In our insurance market, there are two types of operation, that is, life insurance and non-life insurance, but the business scale of the two types has a long way to go. According to the data, the average premium income of whole life insurance market of the personal accident and health insurance is about NT$58 billion and NT$126 billion per year respectively among these five years. Relative to the non-life insurance which premium income is about NT$110 billion, it’s really a captivating and unlimited new market that the non-life insurance can take the risk about the personal accident and health insurance. From my point of view, it will be the main key to break through the bottleneck of operation of the non-life insurance market. Not only the whole insurance market will be changed but also it can bring multi-choice and influence to consumers.

    Under this background, the main task of this research is discussing the non-life insurance’s result of operation the personal accident insurance. It has a real case that also includes the product of development, marketing, underwriter and claim for further discussion and analysis. According to the research of this case, it can generalize some points as below. The first is about the tactic of operation: we will choice the way of marketing way of channel if we consider the growth of premium income as primary issue. What is called” Someone will be a winner if he controls the channel”. In our company, the business of channel was occupied about 73% of the personal accident insurance and the claim also in the same situation was about 76% over the past two years. Unfortunately, the result of operation is “Control the channel will make someone success and failure”, so the key point of operation is how to enhance the management of channel. The second is about the statistics of claim: we compared with the data of life and non-life insurance and find some related trends, but there is a phenomenon of related aggravation, such as rate of average death, men are five times more than women in non-life insurance but only three times in life


    insurance statistics; the average indemnity of death is about NT$2.3 million in non-life insurance which is one time higher than life insurance market and especially with men that age level among in 50~59 years old. On the basis of above mentioned, it shows the problem of this product have higher indemnification but lower premium income. The third is about the problem of lack of manpower and inadequate experience, in addition, it also lack such relevant professional personnel as medical, legal and investigative, etc. So it can’t offer the demand of real operation in the underwriting and claim process.

    The law of insurance has already opened that the non-life insurance can operate the personal accident insurance after revision two times in our country. Moreover, we believe that will be passed through about the non-life insurance also can operate the health insurance by the legislative rapidly. After the analysis, the conclusion of this research is finding out the question and reason of operation and offering the suggestion of improvement. I hope it can provide some recommendations for the non-life insurance that will operate the personal accident insurance or oncoming of the health insurance.


    Key words: Personal Accident Insurance、Combined Ratio、Excess of Loss
    "第一章 緒論.........................................................................1
    第一節 研究背景與動機...............................................1
    第二節 研究目的與限制...............................................3
    第三節 研究方法與架構...............................................4
    第四節 相關文獻回顧...................................................6

    第二章 產物保險業經營傷害險現況....................................10
    第一節 產物保險業整體營運概況...............................10
    第二節 產物保險業經營傷害險緣由............................22
    第三節 產物保險業傷害險經營現況............................26

    第三章 個案傷害險相關作業說明.......................................35
    第一節 個案背景說明.................................................35
    第二節 個案傷害險作業流程說明...............................36
    第三節 個案傷害險經營績效……................................48

    第四章 個案傷害險經營分析...............................................51
    第一節 個案傷害險營運資料分析................................51
    第二節 個案傷害險作業問題分析................................62
    第三節 個案傷害險經營分析與建議............................69
    第四節 產險業傷害險經營分析...................................74

    第五章 未來健康險之經營..................................................76
    第一節 健康險市場現況………....................................76
    第二節 傷害險與健康險之比較...................................80
    第三節 未來健康險經營分析.......................................85

    第六章 結論與建議.............................................................90
    第一節 結論................................................................91
    第二節 建議................................................................93

    參考文獻...............................................................................98

    表目錄

    (表2-1) 85-94年財產保險與汽車保險業務概況...............12
    (表2-2) 產險業財務結構比較表.......................................18
    (表2-3) 產險業財務業務指標比較分析表.........................19
    (表2-4) 保險險別區分表..................................................24
    (表2-5) 產物保險業傷害險保費收入統計表.....................27
    (表2-6) 人身保險業保費收入統計表................................28
    (表2-7) 人身保險業給付統計表.......................................29
    (表3-1) 保險業各作業面所要達成的目標表.....................36
    (表3-2) 傷害險殘廢等級與給付比例表............................39
    (表3-3) 92-95年傷害險核保利潤分析表.........................49
    (表4-1) 92-95年保費收入及理賠金額.............................51
    (表4-2) 94-95年承保來源保費收入分佈表......................52
    (表4-3) 94-95年承保地區保費收入及件數分佈表...........52
    (表4-4) 94-95年承保年齡保費收入及件數分佈表...........53
    (表4-5) 94-95年承保性別保費收入及件數分佈表...........53
    (表4-6) 95年職業類別賠款佔率表..................................54
    (表4-7) 90-91年觀察年度職業類別粗死亡率..................55
    (表4-8) 94-95年死亡率表..............................................55
    (表4-9) 90-91年觀察年度性別粗死亡率.........................56
    (表4-10) 95年地區別賠款佔率表......................................57
    (表4-11) 94-95年通路別賠款佔率表.................................57
    (表4-12) 94-95年年齡及性別理賠損失率表......................58
    (表4-13) 94-95年年齡別理賠金額佔率表..........................59
    (表4-14) 出險原因代號分類表...........................................59
    (表4-15) 94-95年出險原因佔率表.....................................60
    (表4-16) 94-95年年齡別出險原因理賠金額佔率表............61
    (表5-1) 人身保險業健康險保費收入統計表......................78
    (表5-2) 人身保險業健康險給付統計表.............................78
    (表5-3) 個人健康險新契約承保件數及給付件數表............79

    圖目錄

    (圖1-1) 研究架構流程圖...............................................5
    (圖2-1) 94年產險業各險種保費收入佔率圖......................11
    (圖2-2) 94年各種汽車險保險保費收入佔率圖..................12
    (圖2-3) 93-94年本國產險公司業務排名圖........................14
    (圖3-1) 商品研發及送審作業流程圖.................................37
    (圖3-2) 核保作業流程圖............................................43
    (圖3-3) 理賠作業流程圖..................................................45
    Reference: 中文書籍、論文及期刊：
    1.台灣壽險業個人傷害險年度經驗損失率研究報告，人壽保險商業同業公會，2004。
    2.江傳賢、許沖河、賈銘賢、呂廣盛，傷害及健康保險，財團法人保險事業發展中心，2001。
    3.伍建勳，財產保險業經營團體傷害保險之探討，政治大學，碩士論文，2004。
    4.呂廣盛，我國產、壽險業經營個人傷害險之比較分析，逢甲大學，碩士論文，2003。
    5.保險法令彙編，財團法人保險事業發展中心，2003修訂五版。
    6.我國產險行銷通路未來發展趨勢，財團法人保險事業發展中心，2004。
    7.林榮宗，新修訂傷害保險單示範條款公佈實施，保險大道，第49期，2006。
    8.林淑貞，台灣地區個人傷害險意外死亡損失率之研究，逢甲大學，碩士論文，2003。
    9.風險管理學會，人身風險管理與理財，智勝文化，2001。
    10.高志強，個人意外傷害保險純保費費率充份性之研究，逢甲大學，碩士論文，1992。
    11.凌氤寶、康裕民、陳森松，保險學—理論與實務，華泰文化， 1998。
    12.袁國寧，產物保險公司經營傷害保險與健康保險應注意事項之研究，逢甲大學，研究報告。
    13.張素屏，現行個人化傷害保險經驗分析與探討，逢甲大學，碩士論文，2003。
    14.黃淨蘭，我國產險業經營傷害險費率之探討，逢甲大學，碩士論文，2004。
    15.黃雯婌，我國產險業經營個人健康保險意向與困難之研究，逢甲大學，碩士論文，2004。
    16.郭彰雄，我國商業性個人健康保險經營盈虧趨勢之研究，政治大學，碩士論文，1994。
    17.趙志偉，我國產險業經營傷害險可行性之研究，逢甲大學，碩士論文，1991。
    18.楊誠對，意外保險—理論與實務，1999。
    19.劉俊鵬，人身保險實務，金融出版社，1996。
    20.廖述源，財產保險經營，財團法人保險事業發展中心，2006。
    21.鄭雅雯，財產保險業經營面面觀，現代保險，第174期。
    22.蕭文，健康保險概論，三民書局，1992。
    23.蘇文斌，意外保險，三民書局，1993。
    相關網站：
    24.人壽保險商業同業公會，(http://www.lia-roc.org.tw/)
    25.中華民國精算學會，(http://www.airc.org.tw/)
    26.全國法規資料庫，(http://www.law.moj.gov.tw/)
    27.行政院衛生署，(http://www.doh.gov.tw/statistic/data/)
    28.行政院金融監督管理委員會，(http://www.fscey.gov.tw/)
    39.財團法人保險事業發展中心，(http://www.tii.org.tw/)
    30.產物保險商業同業公會，(http://www.nilia.org.tw/
    Description: 碩士
    國立政治大學
    經營管理碩士學程(EMBA)
    94932218
    95
    Source URI: http://thesis.lib.nccu.edu.tw/record/#G0094932218
    Data Type: thesis
    Appears in Collections:[Executive Master of Business Administration] Theses

    Files in This Item:

    File SizeFormat
    index.html0KbHTML2208View/Open


    All items in 政大典藏 are protected by copyright, with all rights reserved.


    社群 sharing

    著作權政策宣告 Copyright Announcement
    1.本網站之數位內容為國立政治大學所收錄之機構典藏，無償提供學術研究與公眾教育等公益性使用，惟仍請適度，合理使用本網站之內容，以尊重著作權人之權益。商業上之利用，則請先取得著作權人之授權。
    The digital content of this website is part of National Chengchi University Institutional Repository. It provides free access to academic research and public education for non-commercial use. Please utilize it in a proper and reasonable manner and respect the rights of copyright owners. For commercial use, please obtain authorization from the copyright owner in advance.

    2.本網站之製作，已盡力防止侵害著作權人之權益，如仍發現本網站之數位內容有侵害著作權人權益情事者，請權利人通知本網站維護人員(nccur@nccu.edu.tw)，維護人員將立即採取移除該數位著作等補救措施。
    NCCU Institutional Repository is made to protect the interests of copyright owners. If you believe that any material on the website infringes copyright, please contact our staff(nccur@nccu.edu.tw). We will remove the work from the repository and investigate your claim.
    DSpace Software Copyright © 2002-2004  MIT &  Hewlett-Packard  /   Enhanced by   NTU Library IR team Copyright ©   - Feedback