| Notice by the General Office of the China Banking and Insurance Regulatory Commission of Regulating the Health Management Services of Insurance Companies | | 中国银保监会办公厅关于规范保险公司健康管理服务的通知 |
| (No. 83 [2020] of the General Office of the China Banking and Insurance Regulatory Commission) | | （银保监办发〔2020〕83号） |
| All local offices of the China Banking and Insurance Regulatory Commission ("CBIRC"), all insurance companies, and the Insurance Association of China ("IAC"): | | 各银保监局，各保险公司，中国保险行业协会： |
| For the purposes of further implementing the relevant requirements of the Measures for the Administration of Health Insurance (Order No. 3 [2019], CBIRC), regulating the health management services of insurance companies, effectively improving their professional services, and promoting the steady development of commercial health insurance, you are hereby notified of the relevant matters as follows: | | 为进一步落实《健康保险管理办法》（银保监会令2019年第3号）有关要求，规范保险公司健康管理服务行为，切实提升专业化服务水平，促进商业健康保险稳健发展，现就有关事项通知如下： |
| I. Clarifying service requirements | | 一、明确服务要求 |
| 1. The “health management services provided by insurance companies” means any attempt to intervene in health risk factors by monitoring, analyzing, and evaluating the health of clients for purposes of controlling the occurrence and progression of diseases and making them healthy, including health examinations, health consultations, health promotion, disease prevention, chronic disease management, medical services, and rehabilitation care. | | （一）保险公司提供的健康管理服务，是指对客户健康进行监测、分析和评估，对健康危险因素进行干预，控制疾病发生、发展，保持健康状态的行为，包括健康体检、健康咨询、健康促进、疾病预防、慢病管理、就医服务、康复护理等。 |
| 2. The purpose of insurance companies' providing health management services is to reduce disease incidence and improve health by preventing the occurrence of diseases, controlling their progression, and promoting recovery; enrich the content of health insurance business and strengthen the professional ability of risk management; promote the reasonable use of health service resources, optimize the allocation and integration of health service resources. | | （二）保险公司提供健康管理服务的目的，是通过预防疾病发生、控制疾病发展、促进疾病康复，降低疾病发生率、提升健康水平；丰富健康保险业务内涵，强化风险管理专业能力；促进健康服务资源的合理使用，优化健康服务资源的配置与整合。 |
| 3. The health management services provided by insurance companies shall comply with the requirements of science, safety, and effectiveness on the premise of complying with relevant laws and regulations of the state, and shall not provide services involving the following circumstances: | | （三）保险公司提供的健康管理服务应当在遵守国家相关法律规定的前提下，符合科学、安全、有效的要求，不得开展涉及以下情形的服务： |
| (1) Services that fall within the scope of the practicing licensing for medical institutions; | | 1.自行开展属于医疗机构执业许可范围内的服务； |
| (2) The safety is indefinite or there are clearly safety problems; | | 2.安全性不确切或明确存在安全性问题； |
| (3) Services involving ethical risks or having ethical issues; | | 3.涉及伦理风险或存在伦理问题； |
| (4) Techniques and methods that have not been medically proven or that have been proven ineffective; | | 4.未经医学证实的技术和方法或已被证实无效的技术和方法； |
| (5) Testing methods that cannot be evaluated objectively or whose results are unreliable; | | 5.无法客观评价或结果不可靠的检测方法； |
| (6) Services that are obviously not related to the health needs of clients; | | 6.与客户健康需求明显不相关联的服务； |
| (7) Other inappropriate services. | | 7.其他不适合开展的服务。 |
| 4. An insurance company providing health management services shall comply with the following requirements: | | （四）保险公司提供健康管理服务应遵循以下要求： |
| (1) The company shall scientifically and reasonably set health management service content and determine service prices according to its own service capabilities, client needs, and health insurance business characteristics; | | 1.根据公司自身服务能力、客户需求和健康保险业务特性，科学合理设定健康管理服务内容、确定服务价格； |
| (2) It shall proactively inform clients about the content, process, standards, deadlines, precautions, and possible risks of health management services, and obtain the informed consent of clients. If a third-party service partner participates, it must be also notified; | | 2.主动告知客户健康管理服务的内容、流程、标准、期限以及注意事项和可能发生的风险，并获得客户的知情同意。如有第三方服务合作机构参与，须一并告知； |
| (3) It shall obtain clients' authorization when obtaining their health data; | | 3.获取客户健康数据时应当获得客户授权同意； |
| (4) Without the authorization of a client, it shall not provide his or her personal information or any health data to others. What it should do is to ensure data security and protect personal privacy in accordance with the law; | | 4.未经客户授权不得对外提供客户个人信息或任何健康数据，依法保证数据安全和保护个人隐私； |
| (5) It shall establish a mechanism for evaluation feedback and complaint handling for client health management services; | | 5.建立客户健康管理服务评价反馈及投诉处理机制； |
| (6) Other requirements. | | 6.其他要求。 |
| 5. If the health management services provided by an insurance company is included in the insurance product liability clause, its apportioned cost shall not exceed 20% of the net insurance premium, and the main content of health management services shall be specified in the clause, and at the same time the pricing basis shall be stated in the actuarial report. | | （五）保险公司提供的健康管理服务包含在保险产品责任条款中的，其分摊成本不得超过净保险费的20%，并应在条款中明确健康管理服务的主要内容，同时在精算报告中说明其定价依据。 |
If an insurance company provides health management services separately, it shall sign a health management service contract and indicate service content and price therein.
．．．．．． | | 保险公司单独提供健康管理服务的，应签订健康管理服务合同并在合同中注明服务内容和服务价格。
．．．．．． |
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