Theory Of Health Insurance Payment Rules

Health insurance is one type of insurance between personal insurance and property insurance, which could be applied to not only the payment rules, but also the compensatory rules with its dual property. Previously, there are a lot of scholars who have done many systematic arguments and summaries with regard to the compensatory rules which adopted by health insurance, however, the research on the original part of health insurance---the payment rules have long been ignored. Frankly speaking, compared with the health insurance of compensatory property, the health insurance of payment property assumes a higher moral risks, and thus deserves our greater attention.According to the health insurance contracts concluded under the compensatory rules,when insurance accidents happen, the insurer could pay the insurance money within the coverage of insurance amount in accordance with the insured’s actual loss. The property of the insurance amount is the highest payment amount, which could be applied to rules of double insurance, excess insurance and insurance subrogation. According to the health insurance contracts concluded under the payment rules, at the time of the contracting, the insurance amount and ways to decide the amount have also been stipulated. When the insurance accidents happen, the insurer only need to pay the alreaday stipulated amount.The property of the insurance amount is the final payment amount,which could not be applied to rules of double insurance and insurance subrogation. The abnormally high insurance amount resulted from the malicious double insurance is one of the inducements of moral risks, however, there is still a lack of restrictions on it in our legislation, and also lacking investigations in the academic field. Therefore, this paper intends to specify the application coverage and principles of payment rules in health insurance, and also puts forward some proposals targeting at the moral risks on the base of the combination of foreign experience and our country’s actual condition.