Measures for the Administration of Health Insurance
Measures for the Administration of Health Insurance
Measures for the Administration of Health Insurance
Order of China Insurance Regulatory Commission [2006] No. 8
August 7, 2006
The Measures for the Administration of Health Insurance, which were deliberated and adopted at the chairmen's executive meeting of China Insurance Regulatory Commission on June 12th, 2006, are hereby promulgated and shall come into force as of September 1, 2006.
Chairman Wu Dingfu
Appendix: Measures for the Administration of Health Insurance
Chapter I General Provisions
Article 1 For the purpose of promoting the development, regulating the business activities of health insurance and protecting the legitimate rights and interests of the parties concerned in health insurance activities, these Measures are formulated in accordance with the Insurance Law of the People's Republic of China (hereinafter referred to as the Insurance Law).
Article 2 The term of health insurance in the present Measures refers to the insurance whereby an insurance company pays insurance money for the losses caused by health reasons by means of sickness insurance, medical insurance, disability income insurance and care insurance, etc.
The term of sickness insurance in the present Measures refers to the insurance which takes the occurrence of the diseases stipulated in the insurance contract as the condition for the payment of insurance money.
The term of medical insurance in the present Measures refers to the insurance which takes the occurrence of the medical behaviors stipulated in the insurance contract as the condition for the payment of insurance money, and provides guarantee for insurant's medical expense during the treatment period.
The term of disability income insurance in the present Measures refers to the 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 guarantee for the income decrease or interruption of the insurant within a certain period.
The term of care insurance in the present Measures refers to the insurance which takes the occurrence of required care caused by impediments in daily life activities as the condition for the payment of insurance money, and provides guarantee for the expenses of caring the insurant.
Article 3 Health insurance may be classified into long-term health insurance and short-term insurance according to the insurance period.
Long-term health insurance refers to the health insurance the insurance period of which is more than 1 year, or though less than 1 year but contains a warranty renewal insurance clause.
Short-term health insurance refers to the health insurance the insurance period of which is 1 year or less and does not contain a warranty renewal insurance clause.
The term of warranty renewal insurance clause refers to the contractual stipulation that the insurance company must continue underwriting the insurance in accordance with the stipulated premium rate and original clauses after the insurant files the application of renewal upon the expiration of the preceding insurance period.
Article 4 Medical insurance may be 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 the medical insurance that the amount of insurance money is determined in accordance with the stipulated standards on the basis of the insurant's medical expenses that have actually occurred.
Rationed payment medical insurance refers to the medical insurance that the insurance money is paid in accordance with the stipulated amount.
The payment amount of compensatory medical insurance shall not exceed the insurant's medical expense that has actually occurred.
Article 5 China Insurance Regulatory Commission (hereinafter referred to as the CIRC) shall regulate the activities of the insurance company that engages in health insurance business in accordance with law.
Article 6 These Measures are not applicable to the insurance companies that provide the entrusted management services that do not undertake insurance risks.
Chapter II Management and Operation
Article 7 Life insurance companies and health insurance companies established according to law may, upon the examination and approval of the CIRC, engage in the business of health insurance.
Other insurance companies other than those stipulated in the preceding paragraph may, upon the examination and approval of the CIRC, engage in the business of short-term health insurance.
Article 8 The insurance company that engages in health insurance shall satisfy the following conditions on a persistent basis:
1. Establish a separate accounting system for health insurance business;
2. Establish a health insurance actuarial system and risk management system;
3.
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