Administrative Measures for Health Insurance
Administrative Measures for Health Insurance
Administrative Measures for Health Insurance
Order of the China Banking and Insurance Regulatory Commission [2019] No.3
October 31, 2019
The Administrative Measures for Health Insurance, which were adopted at the sixth session of the chairmen's meeting of the China Banking and Insurance Regulatory Commission in 2018, are hereby promulgated for implementation as of December 1, 2019.
Chairman Guo Shuqing
Administrative Measures for Health Insurance
Chapter I General Provisions
Article 1 For the purpose of promoting the development of health insurance, regulating the business activities of health insurance, protecting the legitimate rights and interests of the parties concerned in health insurance activities and enhancing the level of protecting the health of the masses, the Administrative Measures for Health Insurance (the "Measures") are formulated in accordance with the Insurance Law of the People's Republic of China (the "Insurance Law") and other laws and administrative regulations.
Article 2 "Health insurance" in the Measures refers to insurance whereby an insurance company pays insurance money in the event of any insurance events due to health or medical treatment of the insured, mainly including medical insurance, sickness insurance, disability income insurance, care insurance, medical accident insurance, etc.
Medical insurance herein refers to insurance providing a guarantee for the insurant's medical treatment, recovery and others as agreed in the insurance contract.
Sickness insurance herein refers to insurance providing a guarantee for the insurant in the event of any diseases stipulated in the insurance contract.
Disability income insurance herein refers to insurance which takes the loss of working ability caused by the diseases or accidental injuries stipulated in the insurance contract as the condition for the payment of insurance money, and provides a guarantee for the income decrease or interruption of the insurant within a certain period.
Care insurance herein refers to insurance providing a guarantee for the expenses of caring for the insurant caused by impediments to daily life activities as agreed in the insurance contract.
Medical accident insurance referred to herein refers to insurance providing a guarantee for the insurant's medical damages that cannot be blamed on medical institutions or medical personnel in accordance with the insurance contract.
Article 3 Health insurance, as an important part of the nationwide multi-level medical insurance system, adheres to its function to protect health, encourages insurance companies to, under the principles of prudence and stability, continuously enrich health insurance products, improve health insurance services, expand health insurance coverage, reduce health insurance prices and operating costs by effective management and market competition and raise the level of protection.
Article 4 Health insurance is classified into long-term health insurance and short-term insurance according to the insurance period.
Long-term health insurance refers to health insurance the insurance period of which is more than one year, or though less than one year contains a warranty renewal insurance clause.
The period of long-term care insurance may not be less than five years.
Short-term health insurance refers to health insurance the insurance period of which is one year or less and does not contain a warranty renewal insurance clause.
Warranty renewal insurance clause refers to the contractual convention that the insurance company must continue underwriting the insurance based on the previous terms and conditions and at the stipulated premium rate after the insurant files an application for renewal upon the expiration of the preceding insurance period.
Article 5 Medical insurance is classified into compensatory medical insurance and rationed payment medical insurance according to the nature of the payment of insurance money.
Compensatory medical insurance refers to medical insurance where the amount of insurance money is determined in accordance with the stipulated standards on the basis of the insurant's medical and recovery expenses that have actually been incurred.
Rationed payment medical insurance refers to medical insurance where the insurance money is paid in accordance with the stipulated amount.
The payment amount of compensatory medical insurance may not exceed the insurant's medical and recovery expenses that have actually been incurred.
Article 6 The China Banking and Insurance Regulatory Commission (the "CBIRC") will regulate the activities of insurance companies that engage in health insurance business in accordance with the law, administrative regulations and as authorized by the State Council.
Article 7 The Measures will apply to the policy insurance business related to health insurance carried out by insurance companies, unless otherwise stipulated by the State.
The Measures are not applicable to insurance companies that provide entrusted management services that do not undertake insurance risks.
Chapter II Management and Operation
Article 8 Health insurance companies, life insurance companies and pension insurance companies established according to the law may, upon examination and approval by the CBIRC, engage in the business of health insurance.
Other insurance companies other than those stipulated in the preceding paragraph may, upon examination and approval by the CBIRC, engage in the business of short-term health insurance.
Article 9 Except health insurance companies, an insurance company intending to operate health insurance business is required to set up a specialized health insurance business unit, which shall satisfy the following conditions on a continuous basis:
1.
......
Order of the China Banking and Insurance Regulatory Commission [2019] No.3
October 31, 2019
The Administrative Measures for Health Insurance, which were adopted at the sixth session of the chairmen's meeting of the China Banking and Insurance Regulatory Commission in 2018, are hereby promulgated for implementation as of December 1, 2019.
Chairman Guo Shuqing
Administrative Measures for Health Insurance
Chapter I General Provisions
Article 1 For the purpose of promoting the development of health insurance, regulating the business activities of health insurance, protecting the legitimate rights and interests of the parties concerned in health insurance activities and enhancing the level of protecting the health of the masses, the Administrative Measures for Health Insurance (the "Measures") are formulated in accordance with the Insurance Law of the People's Republic of China (the "Insurance Law") and other laws and administrative regulations.
Article 2 "Health insurance" in the Measures refers to insurance whereby an insurance company pays insurance money in the event of any insurance events due to health or medical treatment of the insured, mainly including medical insurance, sickness insurance, disability income insurance, care insurance, medical accident insurance, etc.
Medical insurance herein refers to insurance providing a guarantee for the insurant's medical treatment, recovery and others as agreed in the insurance contract.
Sickness insurance herein refers to insurance providing a guarantee for the insurant in the event of any diseases stipulated in the insurance contract.
Disability income insurance herein refers to insurance which takes the loss of working ability caused by the diseases or accidental injuries stipulated in the insurance contract as the condition for the payment of insurance money, and provides a guarantee for the income decrease or interruption of the insurant within a certain period.
Care insurance herein refers to insurance providing a guarantee for the expenses of caring for the insurant caused by impediments to daily life activities as agreed in the insurance contract.
Medical accident insurance referred to herein refers to insurance providing a guarantee for the insurant's medical damages that cannot be blamed on medical institutions or medical personnel in accordance with the insurance contract.
Article 3 Health insurance, as an important part of the nationwide multi-level medical insurance system, adheres to its function to protect health, encourages insurance companies to, under the principles of prudence and stability, continuously enrich health insurance products, improve health insurance services, expand health insurance coverage, reduce health insurance prices and operating costs by effective management and market competition and raise the level of protection.
Article 4 Health insurance is classified into long-term health insurance and short-term insurance according to the insurance period.
Long-term health insurance refers to health insurance the insurance period of which is more than one year, or though less than one year contains a warranty renewal insurance clause.
The period of long-term care insurance may not be less than five years.
Short-term health insurance refers to health insurance the insurance period of which is one year or less and does not contain a warranty renewal insurance clause.
Warranty renewal insurance clause refers to the contractual convention that the insurance company must continue underwriting the insurance based on the previous terms and conditions and at the stipulated premium rate after the insurant files an application for renewal upon the expiration of the preceding insurance period.
Article 5 Medical insurance is classified into compensatory medical insurance and rationed payment medical insurance according to the nature of the payment of insurance money.
Compensatory medical insurance refers to medical insurance where the amount of insurance money is determined in accordance with the stipulated standards on the basis of the insurant's medical and recovery expenses that have actually been incurred.
Rationed payment medical insurance refers to medical insurance where the insurance money is paid in accordance with the stipulated amount.
The payment amount of compensatory medical insurance may not exceed the insurant's medical and recovery expenses that have actually been incurred.
Article 6 The China Banking and Insurance Regulatory Commission (the "CBIRC") will regulate the activities of insurance companies that engage in health insurance business in accordance with the law, administrative regulations and as authorized by the State Council.
Article 7 The Measures will apply to the policy insurance business related to health insurance carried out by insurance companies, unless otherwise stipulated by the State.
The Measures are not applicable to insurance companies that provide entrusted management services that do not undertake insurance risks.
Chapter II Management and Operation
Article 8 Health insurance companies, life insurance companies and pension insurance companies established according to the law may, upon examination and approval by the CBIRC, engage in the business of health insurance.
Other insurance companies other than those stipulated in the preceding paragraph may, upon examination and approval by the CBIRC, engage in the business of short-term health insurance.
Article 9 Except health insurance companies, an insurance company intending to operate health insurance business is required to set up a specialized health insurance business unit, which shall satisfy the following conditions on a continuous basis:
1.
......