CN111652744A

CN111652744A - Health risk product configuration method, device, medium and equipment

Info

Publication number: CN111652744A
Application number: CN202010465850.4A
Authority: CN
Inventors: 董楠; 高英明; 欧龙平; 王一涵; 徐义博
Original assignee: Taikang Insurance Group Co Ltd
Current assignee: Taikang Insurance Group Co Ltd
Priority date: 2020-05-28
Filing date: 2020-05-28
Publication date: 2020-09-11
Anticipated expiration: 2040-05-28
Also published as: CN111652744B

Abstract

The invention relates to a health risk product configuration method, a health risk product configuration device, a health risk product configuration medium and health risk product configuration equipment. The server side can respond to the responsibility plan configuration page to the terminal side when receiving the health insurance product configuration request sent by the terminal side, each insurance responsibility in the responded responsibility plan configuration page can correspond to an insurance responsibility tree with a hierarchical structure, and the server side can receive configuration information which is sent by the terminal side and corresponds to the responded responsibility plan configuration page, so that the configuration of the insurance responsibility trees is realized. Therefore, the hierarchical configuration of the insurance responsibilities in the health insurance product can be realized through the configuration of the insurance responsibility tree, and the accuracy of the configuration of the health insurance product is improved.

Description

Health risk product configuration method, device, medium and equipment

Technical Field

The invention relates to the technical field of communication, in particular to a health risk product configuration method, a health risk product configuration device, a health risk product configuration medium and health risk product configuration equipment.

Background

The premium calculation and claim settlement of health insurance products are different from the traditional insurance products, and are mainly characterized in that the health insurance actuations are related to the occurrence rate of diseases and the change of medical expenses related to the health condition and the behavior habits of people, and the premium calculation and claim settlement are complex due to more factors needing to be considered.

Statistical data show that the incidence rate of medical insurance claim settlement is 6-8%, wherein the supplementary medical insurance business of an enterprise is up to 25-30%, which is far higher than the level of 0.3-0.4% of life insurance, and the frequent claim settlement also determines that a large amount of manpower and material resources are required to be invested in the aspect of claim settlement.

The existing health insurance products are obtained by modifying on the basis of the traditional life insurance products, the insurance responsibility is not refined enough, and the accurate configuration of the health insurance products cannot be realized.

Disclosure of Invention

The embodiment of the invention provides a health risk product configuration method, a health risk product configuration device, a health risk product configuration medium and health risk product configuration equipment, which are used for solving the problem that the health risk product configuration is not accurate enough.

The invention provides a health risk product configuration method, which comprises the following steps:

receiving a health insurance product configuration request sent by a terminal;

responding a responsibility plan configuration page to the terminal according to the received health insurance product configuration request, wherein each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree with a hierarchical structure;

receiving configuration information corresponding to the responsibility plan configuration page sent by the terminal, wherein the configuration information comprises the configuration of the insurance responsibility tree;

the configuration of the insurance responsibility tree included in the configuration information includes calling information of pre-configured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility.

In a preferred embodiment, each level of an insurance responsibility tree includes at least one insurance responsibility.

In a preferred embodiment, the configuration information configures insurance responsibility including medical service detail information for settlement.

In a preferred embodiment, the responsibility plan configuration page further comprises the configuration of insurance responsibility rules;

the configuration information further includes a configuration of insurance responsibility rules, wherein one configured insurance responsibility rule corresponds to at least one insurance responsibility.

In a preferred embodiment, the responsibility plan configuration page also comprises the configuration of the responsibility plan basic information and the configuration of the rate;

the configuration information also includes the configuration of the basic information of the responsibility plan and the configuration of the charging rate.

In a preferred embodiment, if at least one of the configuration of insurance responsibility rules, the configuration of responsibility plan basic information and the configuration of rates included in the responsibility plan configuration page includes a predefined insurance factor, the configuration information includes the configuration of the predefined insurance factor;

the insurance factor includes at least one of an underwriting factor, an indemnification factor, and a rate factor.

In a preferred embodiment, the method further comprises:

responding a basic information configuration page of the dangerous case to the terminal according to the received health insurance product configuration request;

and receiving the configuration information corresponding to the basic information configuration page of the dangerous species sent by the terminal.

In a preferred embodiment, the method further comprises:

acquiring verification information corresponding to the received configuration information, and if the verification information is verified to be passed, taking the received configuration information as the configuration information of the health insurance product;

the verification information is obtained by verifying the correctness of the received configuration information.

In a preferred embodiment, verifying the correctness of the received configuration information comprises:

and simulating the insurance application process and the claim settlement process of the health insurance product according to the received configuration information, and verifying the correctness of the received configuration information according to the insurance application process and the claim settlement process.

The invention also provides a health risk product configuration device, comprising:

the receiving module is used for receiving a health insurance product configuration request sent by the terminal; receiving configuration information corresponding to a responsibility plan configuration page sent by the terminal;

the response module is used for responding a responsibility plan configuration page to the terminal according to the received health insurance product configuration request, wherein each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure;

the configuration information comprises the configuration of the insurance responsibility tree;

The present invention also provides a non-volatile computer storage medium having stored thereon an executable program for execution by a processor to implement the method as described above.

The invention also provides a health risk product configuration device comprising at least one processor; and a memory communicatively coupled to the at least one processor; wherein the memory stores instructions executable by the at least one processor to enable the at least one processor to perform the steps of the method as described above.

According to the scheme provided by the embodiment of the invention, when receiving the health insurance product configuration request sent by the terminal side, the server side can respond to the responsibility plan configuration page to the terminal side, each insurance responsibility in the responded responsibility plan configuration page can correspond to an insurance responsibility tree with a hierarchical structure, and the server side can receive the configuration information which is sent by the terminal side and corresponds to the responded responsibility plan configuration page, so that the configuration of the insurance responsibility tree is realized. Therefore, hierarchical configuration of insurance responsibilities in the health insurance product can be realized through configuration of the insurance responsibility tree, and accuracy of configuration of the health insurance product is improved through detailed configuration of the insurance responsibilities.

Additional features and advantages of the invention will be set forth in the description which follows, and in part will be obvious from the description, or may be learned by practice of the invention. The objectives and other advantages of the invention will be realized and attained by the structure particularly pointed out in the written description and claims hereof as well as the appended drawings.

Drawings

In order to more clearly illustrate the embodiments of the present invention or the technical solutions in the prior art, the drawings used in the description of the embodiments or the prior art will be briefly described below, it is obvious that the drawings in the following description are only some embodiments of the present invention, and for those skilled in the art, other drawings can be obtained according to the drawings without creative efforts.

FIG. 1 is a schematic flow chart of a health risk product configuration method according to an embodiment of the present invention;

fig. 2 is a schematic diagram of a configuration page according to an embodiment of the present invention;

FIG. 3 is a schematic diagram of a rate configuration prototyping page provided in accordance with an embodiment of the present invention;

FIG. 4 is a schematic diagram of a responsibility plan configuration page according to an embodiment of the present invention;

FIG. 5 is a schematic diagram of a health insurance product configuration design according to a second embodiment of the present invention;

FIG. 6 is a schematic diagram of a health insurance product configuration process according to a second embodiment of the present invention;

FIG. 7 is a schematic structural diagram of a health risk product allocation apparatus according to a fourth embodiment of the present invention;

FIG. 8 is a schematic flow chart of a health risk product configuration method according to a fifth embodiment of the present invention;

fig. 9 is a schematic structural diagram of a health risk product allocation device according to a sixth embodiment of the present invention;

fig. 10 is a schematic structural diagram of a health risk product configuration device according to a seventh embodiment of the present invention.

Detailed Description

Because the insurance responsibility is not refined enough when the health insurance product obtained by transformation is transformed on the basis of the traditional life insurance product, and the accurate configuration of the health insurance product cannot be realized, the invention provides a health insurance product configuration scheme, the refinement of the insurance responsibility can be realized through the hierarchical configuration of the insurance responsibility, the accuracy of the health insurance product configuration is improved, the service items can be refined and automatically matched with the insurance responsibility of the hierarchical configuration during claim settlement, and the aim of effectively controlling the cost is achieved.

In embodiments of the present invention, a responsibility plan may be understood as a product, and an insurance responsibility may be understood as a definition of a guarantee content of the product. One responsibility plan may correspond to at least one insurance responsibility.

Further, in the scheme of the invention, the medical service detail configuration can be carried out in the insurance responsibility, so that the insurance responsibility can be further refined.

In addition, in the scheme of the invention, the insurance factor and the pre-configured insurance responsibility can be also pre-defined, and when the health insurance product is configured, the pre-defined insurance factor and the pre-configured insurance responsibility are reused, so that the system resource is saved, and a large amount of repetitive work is reduced.

In the embodiments of the present invention, the insurance factor may be understood as an influence parameter commonly used in insurance and claim settlement, and may include, but is not limited to, an underwriting factor, a claim settlement factor, and a rate factor.

An underwriting factor may be understood as a parameter used in the process of underwriting. For example, if a health risk product is only allowed to be applied to people under 60 years old, an age factor is required to block the application to people over 60 years old, and then age can be used as an underwriting factor.

Claim factors are understood to be parameters used in the process of claim verification. For example, if a health risk product belongs to an accident and a claim is made when the cause of the accident is non-accident, the cause of the accident can be used as a claim factor. Then no claims are made when the insured reports that the selected cause of the accident was non-unexpected.

Claim factors are understood to be limiting parameters that are calculated when an insured claim is made. For example, if the amount of a health insurance product is 2000 dollars, the amount of the product can be used as a claim factor. Claim free amount, claim free days, sub-limit, daily limit, proportion of claims, etc. are also understood as claim factors.

The rate factor can be understood as an influencing parameter of the premium for calculating the premium to be paid by the applicant during the application of the premium. For example, if smoking increases the risk of certain diseases, it is possible to define whether smoking is a rate factor, and whether smoking is a different rate, i.e. a different premium.

In order to make the objects, technical solutions and advantages of the present invention clearer, the present invention will be described in further detail with reference to the accompanying drawings, and it is apparent that the described embodiments are only a part of the embodiments of the present invention, not all of the embodiments. All other embodiments, which can be derived by a person skilled in the art from the embodiments given herein without making any creative effort, shall fall within the protection scope of the present invention.

It should be noted that, the "plurality" or "a plurality" mentioned herein means two or more. "and/or" describes the association relationship of the associated objects, meaning that there may be three relationships, e.g., a and/or B, which may mean: a exists alone, A and B exist simultaneously, and B exists alone. The character "/" generally indicates that the former and latter associated objects are in an "or" relationship.

The terms "first," "second," and the like in the description and in the claims, and in the drawings described above, are used for distinguishing between similar elements and not necessarily for describing a particular sequential or chronological order. It is to be understood that the data so used is interchangeable under appropriate circumstances such that the embodiments of the invention described herein are capable of operation in sequences other than those illustrated or described herein.

Furthermore, the terms "comprises," "comprising," and "having," and any variations thereof, are intended to cover a non-exclusive inclusion, such that a process, method, system, article, or apparatus that comprises a list of steps or elements is not necessarily limited to those steps or elements expressly listed, but may include other steps or elements not expressly listed or inherent to such process, method, article, or apparatus.

Example one

An embodiment of the present invention provides a health risk product configuration method, where a flow of steps of the method may be as shown in fig. 1, and the method includes:

step 101, receiving a health risk product configuration request.

The present embodiment mainly takes a server as an execution subject for explanation. In this step, the server may receive a health risk product configuration request sent by the terminal.

The health insurance product configuration request sent by the terminal may be sent to the server by the terminal receiving the health insurance product configuration request sent by the user. The health insurance product configuration request received by the terminal may be in any form, and this embodiment is not particularly limited.

Step 102, responding to a configuration page.

In this step, the server may respond to the terminal with a responsibility plan configuration page according to the received health insurance product configuration request. On the terminal side, the terminal can receive and display the responsibility plan configuration page responded by the server, so as to receive corresponding configuration information according to the responsibility plan configuration page.

The responsibility plan configuration page can be understood to be used for configuring a responsibility plan corresponding to a risk. In order to implement responsibility refinement, in this embodiment, each insurance responsibility in the responsibility plan configuration page may correspond to an insurance responsibility tree in a hierarchical structure, so that hierarchical configuration of insurance responsibility can be implemented by configuring the insurance responsibility tree, and responsibility refinement is implemented, which is beneficial to automatic settlement and effective control of fees during settlement of a claim.

The responsibility plan configuration page (responsibility plan configuration prototype design page) may correspond to the responsibility plan section in fig. 2, and in the responsibility plan 1, under the configured prevention responsibility, the insurance responsibility (responsibility details) of registration filing, comprehensive oral examination, full-mouth fluorine coating, pit and fissure sealing, ultrasonic tooth cleaning, tooth surface polishing, and oral health promotion is configured. That is, by setting the insurance responsibility tree of the hierarchical structure corresponding to the insurance responsibility, the preventive responsibility can be configured as an insurance responsibility tree of a two-level structure.

Each level of the insurance responsibility tree may be understood to include at least one insurance responsibility. Taking fig. 2 as an example, for the insurance responsibility tree corresponding to the responsibility plan 1, the first level can be understood as including two insurance responsibilities (prevention responsibility and accident responsibility, and responsibilities 3-5 shown in fig. 2 can be understood as not being configured), and further, as shown in fig. 2, the second level of prevention responsibility can be seen as including seven insurance responsibilities (registration, filing, full mouth examination, fluorine coating all over, pit closure, ultrasonic tooth cleaning, tooth surface polishing, and oral health education).

It should be noted that the insurance responsibility defines the guarantee content of the insurance type, and the responsibility plan configuration page may include, in addition to the configuration of the insurance responsibility, the configuration of the insurance responsibility rules to define the limitation conditions of the insurance type. An insurance responsibility rule can be configured for a single insurance responsibility, and if the intersection of a plurality of insurance responsibilities is involved, an insurance responsibility rule can be configured for a plurality of insurance responsibilities. For example, the shared insurance claim factor relates to two insurance responsibilities (two insurance responsibilities correspond to one insurance amount, but the two insurance responsibilities are limited by one shared insurance amount), and then the claim rules are configured for the two insurance responsibilities.

Taking fig. 2 as an example, in the responsibility plan 1, two insurance responsibilities are configured, which are respectively a preventive responsibility and an accidental responsibility. For the prevention responsibility, the exemption amount (claim factor) needs to be configured, and taking fig. 2 as an example, the exemption amount can be configured into 500 yuan. In addition, it is shown in the rule configuration (i.e., insurance responsibility rule configuration) section that the year limit (claim factor) needs to be configured for the prevention responsibility and the accident responsibility, and the year limit may be configured to 3000 yuan, for example, as shown in fig. 2.

It should be noted that, in this embodiment, the insurance factor may be predefined, so that the insurance factor may be reused, time consumption of software development is reduced, and complexity of the software development is reduced.

Therefore, when the claim factors need to be configured, the existing (predefined) claim factors or new claim factors can be selected, and the limit conditions can be configured according to the types of the claim factors. For example, a claim factor of numeric type, may display the equal operator, and appear in an input box prompting the input of a number in the input box; the claim factors of the interval type can be set according to the segmentation rule of different intervals, for example, when the medical fee is 80% within 1000 yuan and 90% above 1000 yuan, the interval can be configured first, and then the claim factors can be configured within the interval. The arrangement of the claim factors can be, but is not limited to, as shown in table 1.

Table 1 arrangement of claim factors

It should be further noted that, in this embodiment, the responsibility plan configuration page may further include configuration of basic responsibility plan information and configuration of the rate. The responsibility plan basic information configuration may be configured, for example, but not limited to, limits of the claim settlement rules (e.g., a premium, a non-claim amount, etc.) including the responsibility plan level, a fixed point hospital configuration, a underwriting factor configuration, a claim factor configuration, and the like.

The fixed-point hospital configuration can be firstly configured to determine whether the insurance responsibility requires the fixed-point hospital, if the configuration requires the fixed-point hospital, the fixed-point hospital can be required to be configured continuously, and if the fixed-point hospital is configured, the number of the allowed fixed-point hospitals can be required to be configured continuously.

Regarding the configuration of the underwriting factor, an existing underwriting factor or a new added underwriting factor can be selected first, and then the operator and condition configuration can be displayed according to the selected underwriting factor type. For example, if gender is selected as male, then the male may be represented as not being allowed to apply the insurance.

The configuration of the claim factors is similar to the underwriting factors, the existing claim factors or the newly added claim factors can be selected firstly, and then the operator and condition configuration can be displayed according to the selected type of the claim factors. For example, if a certain accident risk requires that the accident cause must be an accident, the claim factor of the accident cause may be selected, and then the corresponding value is selected as a non-accident, which represents that no claim is made for the non-accident cause.

The configuration of the underwriting factors and the claims factors can be, but is not limited to, as shown in table 2. Wherein, the value type underwriting factor (or claims factor) can display various operators, and an input box appears for prompting to input numbers in the input box; whether a type of underwriting factor (or claim factor) may prompt a choice to choose from at the time of application; an underwriting factor (or claims factor) of the list type may prompt selection of at least one entry in the list.

TABLE 2 configuration of underwriting and claims factors

In configuring the tariff, an existing tariff factor may be selected or a new tariff factor may be added. Different types of rate factors may exhibit different configurations, which may be, but are not limited to, as shown in Table 3. As shown in Table 3, the type of rate factor, yes or no, can be selected without field configuration, e.g., the premium of an insurance product is related to whether smoking, whether smoking is a type factor. When the rate is configured, the user can select whether to smoke or not and input the amount of the insurance premium in the corresponding cell, wherein the amount of the insurance premium is determined when the user smokes and is yes, and the amount of the insurance premium is determined when the user smokes and is not no; the listing type rate factor allows for the selection of entries without field configuration, e.g., the premium for an insurance product is gender dependent, gender is a listing type factor, and the value is male and female, respectively. When the rate is configured, the user can select the gender and input the gender in the corresponding cell, so that the male insurance premium and the female insurance premium are respectively paid; the rate factor of the interval type may be configured with the maximum value, the minimum value and the step field for different intervals, for example, the premium of one insurance product is related to the age range, for example, 0-18 years, 18-60 years and above 60 years are respectively corresponding to different rates, then the age is a factor of one interval type (of course, the age may be of a numerical type, and different types are selected according to different insurance products), then the age start value, the age end value and the age interval may be configured for pre-generating the age range, and the generation may be edited.

TABLE 3 Rate factor configuration mode

Factor type	Configuration field
		Whether or not to	Is free of
Lists	Is free of
		Interval(s)	Maximum, minimum, stride

When the rate is configured, the direction (horizontal direction and vertical direction) of the rate table can be configured, a rate table is generated after confirmation, and the rate factor can be configured on the rate table. The configuration of the rates also supports the addition of a plurality of rate tables, and the problems of excessively large rate tables and redundant input are avoided. For example, if a certain risk category has mandatory insurance responsibilities related to gender and age and optional insurance responsibilities related to social security, two rate tables may be configured. The first one is a two-dimensional table with gender and age as horizontal and vertical head, and the second one is a tariff table with optional insurance responsibility and social security as horizontal and vertical head. The rates of the two rate tables are in addition relation. The configured rate table can collect information according to the rate factor during the insurance application, thereby determining the insurance fee which should be paid by the insurance applicant. The rate configuration prototyping page is illustrated in the boxed portion (responsibility plan configuration page) of figure 3.

As can be seen from the above description of the configuration of the basic information of the responsibility plan, the configuration of the insurance responsibility rule, and the configuration of the rate, in a possible implementation manner, at least one of the configuration of the insurance responsibility rule, the configuration of the basic information of the responsibility plan, and the configuration of the rate included in the responsibility plan configuration page may further include a predefined insurance factor, and then the predefined insurance factor may be configured to implement the configuration of the health insurance product. That is, at least one of the configuration of the insurance responsibility rules, the configuration of the responsibility plan basic information, and the configuration of the rate included in the responsibility plan configuration page may include the configuration of at least one of the pre-defined underwriting factor, claims factor, and rate factor, so as to reduce the time consumption and complexity of software development.

It should be noted that, in this step, if a health insurance product configuration request is received, in addition to displaying a responsibility plan configuration page to implement configuration of a responsibility plan, a basic information configuration page of an insurance product (insurance product) may also be displayed to implement configuration of basic information corresponding to the health insurance product (insurance product).

The basic information configuration page of the risk seeds can include some basic attributes of the risk seeds, such as policy information, security information, sales information, report information and the like.

For example, the basic information configuration page of the risk type and the responsibility plan configuration page are displayed on the same page, and the basic information configuration page of the risk type may correspond to the basic information part in fig. 2.

As shown in the basic information part of fig. 2, the basic information configuration page of the risk category may include configurations of names of the risk categories, acronyms of the risk categories, codes of the risk categories, names of english, acronyms of english, account marks, predetermined interest rates, risk categories, investment categories, long and short periods, groups, main risk, code of products for monitoring insurance, dates of sale, marks of sale, sales channels, sales areas, insurance application ages of secondary insured persons, maximum guarantee applicable ages, denomination forms, payment years, guarantee years, main risk application marks, and insurance calculation modes.

In a possible implementation manner, the configuration of the predefined insurance factor (which can be understood as including at least one of the underwriting factor, the claims factor and the rate factor) can also be included in the displayed basic information configuration page of the risk category, so as to further reduce the time consumption and complexity of software development.

Further, the present embodiment may further include step 103.

And step 103, receiving configuration information.

In this step, the server may receive configuration information corresponding to the responsibility plan configuration page sent by the terminal to implement configuration of the health insurance product, where the configuration information may include configuration of insurance responsibility trees, and the configuration of an insurance responsibility tree may be understood as including configuration of insurance responsibility under each level thereof, so that the configuration of the insurance responsibility trees may be implemented according to the configuration information, and the configuration of the health insurance product is completed. The configuration information corresponding to the responsibility plan configuration page sent by the terminal may be that, at the terminal side, the terminal receives the configuration information corresponding to the responsibility plan configuration page sent by the user and sends the configuration information to the server.

In order to further implement responsibility refinement, in this embodiment, the insurance responsibility configured by the configuration information may include detail information of medical services for claim settlement, so that the purpose of effective charge control may be further achieved through the detail configuration of medical services.

In a possible implementation manner, the medical service detail may establish a corresponding relationship with the standard code, which is beneficial to matching the standard code with the service code provided by the medical service provider subsequently, and is beneficial to performing claim settlement subsequently according to the standard code, thereby realizing medical fee control.

As shown in fig. 4, the preventive responsibility is provided with medical details, with

standard codes

00010001001, 00010001002, and 00010001003 corresponding to medical details named aspirin, antibiotic, and hospitalization, respectively.

For health insurance products, one disease may correspond to a plurality of different insurance products, and the contents of the guarantee of the products are approximately the same. Just considering that the same insurance responsibility may be included in different health insurance products, the insurance responsibility may be pre-configured to avoid inefficiencies resulting from repeated manual inputs and storage during product configuration. Thus, when the responsibility plan is configured, the pre-configured insurance responsibility can be directly called.

It should be noted that, in this embodiment, a preconfigured insurance responsibility may include at least one level.

Assuming that insurance responsibilities are configured in advance, in this step, the configuration information corresponding to the received responsibility plan configuration page may include calling information of the pre-configured insurance responsibilities and hierarchical information in the corresponding insurance responsibility tree, so as to efficiently implement the configuration of the insurance responsibilities.

Of course, in order to ensure the expandability of the configuration, in this step, the configuration information corresponding to the received responsibility plan configuration page may also include newly added insurance responsibility information and hierarchy information in the corresponding insurance responsibility tree.

That is, in one possible implementation manner, in this step, the configuration information corresponding to the received responsibility plan configuration page may further include call information of the pre-configured insurance responsibility and hierarchy information in the corresponding insurance responsibility tree, and newly added insurance responsibility information and hierarchy information in the corresponding insurance responsibility tree.

That is, in this step, the configuration of the insurance responsibility tree included in the configuration information may include calling information of the pre-configured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility.

It should be noted that, in the responsibility plan configuration page, a preconfigured insurance responsibility can be selected for hierarchical configuration of the insurance responsibility, or an insurance responsibility can be added for hierarchical configuration of the insurance responsibility, so that repeated jumps among pages can be reduced, and the rapid configuration of products can be realized.

In addition, if the configuration page of the responsibility plan also comprises the configuration of the insurance responsibility rules, the configuration information also comprises the configuration of the insurance responsibility rules, wherein one configured insurance responsibility rule corresponds to at least one insurance responsibility.

If the configuration page of the responsibility plan also comprises the configuration of the basic information of the responsibility plan and the configuration of the rate, the configuration information also comprises the configuration of the basic information of the responsibility plan and the configuration of the rate.

And if at least one of the configuration of the insurance responsibility rule, the configuration of the basic information of the responsibility plan and the configuration of the rate in the responsibility plan configuration page comprises the predefined insurance factor, in the step, the configuration information comprises the configuration of the predefined insurance factor.

Of course, if the configuration request of the health risk product is received and the basic information configuration page of the risk category is displayed, in this step, the configuration information corresponding to the basic information configuration page of the risk category can be received. The server can receive configuration information corresponding to the basic information configuration page of the dangerous type sent by the terminal so as to perfect the configuration of the health insurance products. The configuration information corresponding to the basic information configuration page of the dangerous species sent by the terminal may be that, at the terminal side, the terminal receives the configuration information corresponding to the basic information configuration page of the dangerous species sent by the user and sends the configuration information to the server.

In addition, after receiving the configuration information (the configuration information may be understood as the configuration information corresponding to the responsibility plan configuration page, and if the configuration information corresponding to the basic information configuration page of the dangerous type is also received, the configuration information corresponding to the responsibility plan configuration page and the configuration information corresponding to the basic information configuration page of the dangerous type), which is sent by the terminal, the verification information corresponding to the received configuration information may also be obtained, and the verification information may be understood as being obtained by verifying the correctness of the received configuration information.

If the verification information is that the verification is passed, the received configuration information can be used as the configuration information of the health insurance product, so that the health insurance product can be correctly configured.

Of course, if the verification information is that the verification fails, in a possible implementation manner, modification of the received configuration information may be prompted, so that correct configuration of the health risk product may be finally implemented.

In a possible implementation manner, verifying correctness of the received configuration information may include: and simulating the insurance application process and the claim settlement process of the health insurance product according to the received configuration information, and verifying the correctness of the received configuration information according to the insurance application process and the claim settlement process.

That is to say, after the health risk product configuration is completed, in order to ensure the accuracy of the configuration, in this embodiment, a product verification function may be further provided. Wherein, the process of insuring and claiming can be simulated to verify the correctness of the product.

The scheme provided by the first embodiment of the invention is illustrated by the following two embodiments.

Example two

The schematic diagram of the health risk product configuration design provided by the second embodiment of the present invention can be as shown in fig. 5, and when the health risk product configuration design is performed, the health risk product configuration design can be divided into three modules: respectively, the pre-definition of insurance factors (factor management), the pre-configuration of insurance responsibilities (responsibility management) and the configuration of health insurance products (risk species management, in fig. 5, the configuration of responsibility plans in the health insurance product configuration is illustrated).

In this embodiment, factor management may be understood as defining the commonly used influence parameters in application and claim in advance, so as to facilitate the reuse of the influence parameters. When the insurance factor is predefined, the underwriting factor, the claims factor and the rate factor can be defined, so that a user can conveniently and directly configure the defined insurance factor when the insurance responsibility is pre-configured or the health insurance product is configured.

In this embodiment, the responsibility management can be understood as managing insurance responsibility commonly used in the insurance plan. The insurance responsibility is pre-configured, so that a user can directly call the configured insurance responsibility to complete the hierarchical configuration of the insurance responsibility tree when the health insurance product is configured.

It should be noted that, configuring an insurance responsibility in advance may include, but is not limited to, configuring at least one of basic information of the insurance responsibility and content of the insurance responsibility in advance. The insurance responsibility is configured in advance, which can be understood as the same as configuring an insurance responsibility according to the responsibility plan and configuring an insurance responsibility in real time, and the description is not repeated in the following.

Taking fig. 4 as an example, assume that three insurance responsibilities are pre-configured for prevention responsibilities, full oral examination, and full oral fluorine application, respectively. The pre-configured insurance responsibility basic information of the prevention responsibility can include, but is not limited to, the responsibility name being the prevention responsibility, the responsibility code being 001, the responsibility type being the limit, and the claim type being the reimbursement.

The insurance responsibility content may include, but is not limited to, the configuration of medical service details. Taking fig. 4 as an example, in the pre-configured insurance liability content of the prevention liability, the standard codes are 00010001001, 00010001002 and 00010001003, which correspond to the medical service details named aspirin, antibiotics and hospitalization, respectively.

The pre-configured insurance responsibilities may be invoked individually. Of course, in one possible implementation, when an insurance responsibility is pre-configured, the insurance responsibility may be configured in at least one level. That is, the insurance responsibility content of the pre-configured insurance responsibility may include the responsibility details (of course, each responsibility detail may further include the responsibility details of the next level), so that the pre-configured insurance responsibility may be called compositely. Taking fig. 5 as an example, it is assumed that two insurance responsibilities are pre-configured, each pre-configured insurance responsibility includes two levels, the insurance responsibilities at the first level may be referred to as responsibilities, and the insurance responsibilities at the second level may be referred to as responsibilities details. The medical service detail configuration can be performed for each insurance responsibility (including the insurance responsibility at the first level and the insurance responsibility at the second level), and the medical service detail configuration corresponding to each liability insurance can be represented by a standard code.

It should be noted that the detail item of responsibility is also an insurance responsibility, but has a hierarchical relationship with other insurance responsibilities, and can be used as an insurance responsibility which is configured and used independently.

It should be further noted that, in order to further save system resources and avoid repetitive work, when performing multi-level configuration on an insurance responsibility, the responsibility detail configuration can be implemented by calling the already configured insurance responsibility.

In the configuration process of the health insurance product, basic information of the dangerous species and configuration of the responsibility plan can be carried out. That is, in the present embodiment, the management of the dangerous seeds can be understood as the management of the dangerous seed information, and the management of the responsibility plan (i.e., the product) is also included. As shown in fig. 5, in the responsibility plan configuration process, the responsibility plan basic information configuration, the responsibility and rule configuration, and the rate configuration may be included. The responsibility and rule configuration may be understood as configuration of insurance responsibility (such as hierarchical configuration of insurance responsibility, configuration of basic information of insurance responsibility, configuration of content of insurance responsibility, and the like), and configuration of insurance responsibility rules. As shown in fig. 5, predefined underwriting factors and claims factors may be applied to the liability plan basic information configuration, predefined claims factors may be applied to the liability and rule configuration, and predefined rate factors may be applied to the rate configuration. And pre-configured insurance responsibility may be applied to the responsibility and rule configuration.

Taking fig. 6 as an example, in the health insurance product configuration process, when a responsibility plan is added, basic information of the responsibility plan may be configured, wherein the configuration may be implemented by adding an underwriting factor and an indemnity factor (i.e., adding a predefined underwriting factor and an indemnity factor);

when adding a responsibility plan, insurance responsibility (simply referred to as responsibility in fig. 6) can be selected, wherein the selection of insurance responsibility can be realized by the added insurance responsibility (i.e. the added pre-configured insurance responsibility), and insurance responsibility rules (which can be understood as configuration insurance responsibility claim rules) can be configured, wherein the configuration can be realized by the added claim factors (i.e. the added pre-defined claim factors);

rates (configuration tariff) may also be configured when adding a liability plan, wherein the configuration may be effected by an added rate factor, i.e. an added predefined rate factor.

The embodiment of the invention fully considers the unique characteristics of health insurance, designs a set of health insurance product configuration scheme, and enables the claim settlement to be refined to a responsibility and responsibility detail item layer when the claim settlement is carried out, thereby achieving the purposes of refining the claim settlement and controlling the fee.

In addition, according to the scheme provided by the embodiment of the invention, due to the flexibility and the adaptability of the configuration of the health insurance product, the development work required before the health insurance product is online can be reduced, and the health insurance product is also beneficial to being online quickly.

The following describes the schemes provided in the first and second embodiments of the present invention by a specific example.

EXAMPLE III

For example, if there is a risk category a, the guarantee information is shown in table 4, and the rate information is shown in table 5, the product configuration can be performed according to the health risk product configuration method provided by the present invention.

In this embodiment, the terminal side may send a health risk product configuration request to the server side upon receiving the request. The server side may configure the page in response to the responsibility plan based on the request. The terminal side may display a responsibility plan configuration page for the server side response. The user can configure basic information of the dangerous species corresponding to the dangerous species A according to a responsibility plan configuration page displayed on the terminal side, can configure two responsibility plans for the dangerous species A, and respectively record the two responsibility plans as plan 1 and plan 2, and respectively configure an insurance responsibility tree for the plan 1 and the plan 2. The insurance responsibility tree corresponding to the plan 1 (the responsibility tree corresponding to the plan 2 is the same as the insurance responsibility tree corresponding to the plan 1) includes an insurance responsibility A and an insurance responsibility B, and the insurance responsibility A includes a responsibility detail item A-1, a responsibility detail item A-2 and a responsibility detail item A-3.

The limit condition (insurance responsibility rule) of each insurance responsibility can be configured after the insurance responsibility tree configuration is completed. The insurance responsibility rules in plan 1 include: the responsibility detail item A-1, the responsibility detail item A-2 and the responsibility detail item A-3 in the insurance responsibility A are all limited for 1 time, and the claim settlement amount of the insurance responsibility B is limited to 3000. The insurance responsibility rules in plan 2 include: the responsibility detail item A-1, the responsibility detail item A-2 and the responsibility detail item A-3 in the insurance responsibility A are limited for 2 times, and the claim settlement limit of the insurance responsibility B is 6000.

Taking the tariff table shown in table 5 as an example, gender may be selected as the horizontal factor and age may be configured as the vertical factor to achieve tariff calculation according to the tariff table.

TABLE 4 product A guarantee Schedule

TABLE 5 product A tariff

After receiving the configuration information sent by the user, the terminal side can send the configuration information to the server side, and the server side can receive and store the configuration information, so that the configuration of the dangerous case A is completed.

Corresponding to the methods provided in the first to third embodiments, the following apparatuses and methods are provided.

Example four

An embodiment of the present invention provides a health risk product configuration device, where the structure of the device may be as shown in fig. 7, and the device includes:

the receiving module 11 is configured to receive a health insurance product configuration request sent by a terminal; receiving configuration information corresponding to a responsibility plan configuration page sent by the terminal;

the response module 12 is configured to respond to a responsibility plan configuration page to the terminal according to the received health insurance product configuration request, where each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure;

the configuration information received by the receiving module 11 includes the configuration of the insurance responsibility tree;

the configuration of the insurance responsibility tree included in the configuration information includes calling information of pre-configured insurance responsibility and hierarchy information of the called insurance responsibility, and/or newly added insurance responsibility information and hierarchy information of the newly added insurance responsibility. In one possible implementation, each level of an insurance responsibility tree includes at least one insurance responsibility. In a possible implementation manner, the insurance responsibility configured by the configuration information received by the receiving module 11 includes medical service detail information for claim settlement.

In a possible implementation manner, if the responsibility plan configuration page displayed by the response module 12 further includes configuration of insurance responsibility rules, the configuration information received by the receiving module 11 further includes configuration of insurance responsibility rules, where one configured insurance responsibility rule corresponds to at least one insurance responsibility.

In a possible implementation manner, if the responsibility plan configuration page displayed by the response module 12 further includes configuration of the basic responsibility plan information and configuration of the rate, the configuration information received by the receiving module 11 further includes configuration of the basic responsibility plan information and configuration of the rate.

In a possible implementation manner, if at least one of the configuration of the insurance responsibility rule, the configuration of the basic information of the responsibility plan, and the configuration of the rate included in the responsibility plan configuration page displayed by the response module 12 includes a predefined insurance factor, the configuration information received by the receiving module 11 includes the configuration of the predefined insurance factor;

In a possible implementation manner, the response module 12 is further configured to respond to the terminal an essential information configuration page of risk types according to the received health risk product configuration request;

the receiving module 11 is further configured to receive configuration information corresponding to the basic information configuration page of the dangerous species sent by the terminal.

In a possible implementation manner, the receiving module 11 is further configured to obtain verification information corresponding to the received configuration information, and if the verification information is that verification is passed, use the received configuration information as the configuration information of the health risk product; the verification information is obtained by verifying the correctness of the received configuration information.

In one possible implementation, verifying the correctness of the received configuration information includes:

EXAMPLE five

The fifth embodiment of the present invention provides a health risk product configuration method, and the present embodiment takes a terminal as an execution subject for description. The flow of steps of the method can be shown in fig. 8, and includes:

step 201, a health risk product configuration request is received.

In this step, the terminal may receive a health insurance product configuration request sent by the user.

Step 202, sending the health risk product configuration request.

In this step, the terminal may send the received health insurance product configuration request to the server.

And step 203, receiving and displaying a responsibility plan configuration page.

In this step, the terminal may receive and display a responsibility plan configuration page responded by the server, where each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree in a hierarchical structure.

Further, the present embodiment may further include step 204.

And step 204, receiving configuration information.

In this step, the terminal may receive configuration information corresponding to a responsibility plan configuration page sent by the user, where the configuration information includes the configuration of the insurance responsibility tree.

Step 205, sending the configuration information.

In this step, the terminal may transmit the received configuration information to the server.

Corresponding to the method provided in the fifth embodiment, the following apparatus is provided.

EXAMPLE six

An embodiment of the present invention provides a health risk product configuration device, where the structure of the device may be as shown in fig. 9, and the device includes:

the receiving module 21 is configured to receive a health insurance product configuration request and a responsibility plan configuration page responded by a server, where each insurance responsibility in the responsibility plan configuration page corresponds to an insurance responsibility tree of a hierarchical structure; the sending module 22 is configured to send the health risk product configuration request to the server; the display module 23 is configured to display the responsibility plan configuration page received by the receiving module.

The receiving module 21 is further configured to receive configuration information corresponding to the responsibility plan configuration page, where the configuration information includes configuration of the insurance responsibility tree; the sending module 22 is further configured to send the configuration information to the server.

Based on the same inventive concept, embodiments of the present invention provide the following apparatus and medium.

EXAMPLE seven

The seventh embodiment of the present invention provides a health risk product configuration device, which may be configured as shown in fig. 10, and includes at least one processor 31; and a memory 32 communicatively coupled to the at least one processor; wherein the memory 32 stores instructions executable by the at least one processor 31, the instructions being executable by the at least one processor 31 to enable the at least one processor 31 to perform the steps of the method according to one or five embodiments of the present invention.

Optionally, the processor 31 may specifically include a Central Processing Unit (CPU), an Application Specific Integrated Circuit (ASIC), one or more integrated circuits for controlling program execution, a hardware circuit developed by using a Field Programmable Gate Array (FPGA), or a baseband processor.

Optionally, the processor 31 may include at least one processing core.

Alternatively, the memory 32 may include a Read Only Memory (ROM), a Random Access Memory (RAM), and a disk memory. The memory 32 is used for storing data required by the at least one processor 31 during operation. The number of the memory 32 may be one or more.

An eighth embodiment of the present invention provides a nonvolatile computer storage medium, where the computer storage medium stores an executable program, and when the executable program is executed by a processor, the method provided in the first or fifth embodiment of the present invention is implemented.

In particular implementations, computer storage media may include: various storage media capable of storing program codes, such as a Universal Serial Bus flash drive (USB), a mobile hard disk, a Read-Only Memory (ROM), a Random Access Memory (RAM), a magnetic disk, or an optical disk.

In the embodiments of the present invention, it should be understood that the disclosed apparatus and method may be implemented in other ways. For example, the above-described embodiments of the apparatus are merely illustrative, and for example, the described unit or division of units is only one division of logical functions, and there may be other divisions when actually implemented, for example, a plurality of units or components may be combined or may be integrated into another system, or some features may be omitted, or not executed. In addition, the shown or discussed mutual coupling or direct coupling or communication connection may be an indirect coupling or communication connection through some interfaces, devices or units, and may be in an electrical or other form.

The functional units in the embodiments of the present invention may be integrated into one processing unit, or each unit may be an independent physical module.

The integrated unit, if implemented in the form of a software functional unit and sold or used as a stand-alone product, may be stored in a computer readable storage medium. Based on such understanding, all or part of the technical solutions of the embodiments of the present invention may be embodied in the form of a software product, which is stored in a storage medium and includes instructions for causing a computer device, such as a personal computer, a server, or a network device, or a processor (processor) to execute all or part of the steps of the methods according to the embodiments of the present invention. And the aforementioned storage medium includes: various media that can store program codes, such as a universal serial bus flash drive (usb flash drive), a removable hard disk, a ROM, a RAM, a magnetic disk, or an optical disk.

As will be appreciated by one skilled in the art, embodiments of the present invention may be provided as a method, system, or computer program product. Accordingly, the present invention may take the form of an entirely hardware embodiment, an entirely software embodiment or an embodiment combining software and hardware aspects. Furthermore, the present invention may take the form of a computer program product embodied on one or more computer-usable storage media (including, but not limited to, disk storage, CD-ROM, optical storage, and the like) having computer-usable program code embodied therein.

The present invention is described with reference to flowchart illustrations and/or block diagrams of methods, apparatus (systems), and computer program products according to embodiments of the invention. It will be understood that each flow and/or block of the flow diagrams and/or block diagrams, and combinations of flows and/or blocks in the flow diagrams and/or block diagrams, can be implemented by computer program instructions. These computer program instructions may be provided to a processor of a general purpose computer, special purpose computer, embedded processor, or other programmable data processing apparatus to produce a machine, such that the instructions, which execute via the processor of the computer or other programmable data processing apparatus, create means for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.

These computer program instructions may also be stored in a computer-readable memory that can direct a computer or other programmable data processing apparatus to function in a particular manner, such that the instructions stored in the computer-readable memory produce an article of manufacture including instruction means which implement the function specified in the flowchart flow or flows and/or block diagram block or blocks.

These computer program instructions may also be loaded onto a computer or other programmable data processing apparatus to cause a series of operational steps to be performed on the computer or other programmable apparatus to produce a computer implemented process such that the instructions which execute on the computer or other programmable apparatus provide steps for implementing the functions specified in the flowchart flow or flows and/or block diagram block or blocks.

While preferred embodiments of the present invention have been described, additional variations and modifications in those embodiments may occur to those skilled in the art once they learn of the basic inventive concepts. Therefore, it is intended that the appended claims be interpreted as including preferred embodiments and all such alterations and modifications as fall within the scope of the invention.

It will be apparent to those skilled in the art that various changes and modifications may be made in the present invention without departing from the spirit and scope of the invention. Thus, if such modifications and variations of the present invention fall within the scope of the claims of the present invention and their equivalents, the present invention is also intended to include such modifications and variations.

Claims

1. A method of health risk product configuration, the method comprising:

receiving a health insurance product configuration request sent by a terminal;

2. The method of claim 1, wherein each level of an insurance responsibility tree includes at least one insurance responsibility.

3. The method of claim 1, wherein the configuration information configures insurance responsibility including medical service detail information for settlement.

4. The method of claim 1, wherein the responsibility plan configuration page further includes a configuration of insurance responsibility rules;

5. The method of claim 4, wherein the responsibility plan configuration page further comprises configuration of responsibility plan basic information and configuration of rates;

6. The method according to claim 5, wherein if at least one of the configuration of insurance responsibility rules, the configuration of responsibility plan basic information, and the configuration of rates included in the responsibility plan configuration page includes a predefined insurance factor, the configuration information includes a configuration of the predefined insurance factor;

7. The method of claim 1, wherein the method further comprises:

8. A health risk product configuration device, the device comprising:

9. A non-transitory computer storage medium storing an executable program for execution by a processor to perform the method of any one of claims 1 to 7.

10. A health risk product configuration device, the device comprising:

at least one processor; and

a memory communicatively coupled to the at least one processor; wherein,

the memory stores instructions executable by the at least one processor to enable the at least one processor to perform the steps of the method of any one of claims 1 to 7.