Regulations Governing Business Solicitation, Policy Underwriting and Claim Adjusting of Insurance Enterprises Article 6

The internal business solicitation system and procedure of an insurance enterprise shall contain and explicitly specify at least the following particulars:1.Qualifications of sales representatives, the types of insurance they may solicit, their on-the-job training, rewards and disciplines, and rights and obligations. On-the-job training includes the insurance enterprises requiring sales representatives to attend annual training on fair treatment of customers over 65 years of age.2.Management measures regarding performance review that links the commissions received by sales representatives to risk exposure and duration of commission payment, solicitation quality, and solicitation dispute.3.Management measures regarding collection of premiums, and requisition of blank conditional receipts or renewal receipts, time of premium collection and turn-in by sales representatives.4.Rules to be complied with by sales channel and the characteristics of such sales channel.5.Matter concerning the applicant and the insured that a sales representative should know well, including at least the following:(1)Basic information:a. Basic information of the applicant and the insured (including at least name, sex/gender, date of birth, Citizen's ID No., and contact information; in the case of a juristic person, its name, representative, address and contact phone number);b. Relationship between the applicant and the insured, and that between the insured and the beneficiary; andc. If the insurance contract is produced in digital insurance policy format, the insurance enterprise shall at least obtain the mobile phone number, email, or other contact method of the applicant and insured deemed as sufficient by the competent authority for transmitting digital documents.d. Other basic information required by the competent authority.(2)Whether the applicant and the insured meet underwriting requirements?(3)The purpose and the needs of the applicant and the insured purchasing insurance.(4)Source of funding for payment of insurance premiums.(5)Evaluating whether customers over 65 years of age have the ability to distinguish situations that are disadvantageous to his or her rights and interests as an insured. However, the preceding provision does not apply if the characteristics of the insurance product are not found to have potential effects and disadvantages on customers over 65 years of age following an evaluation in accordance with Subparagraph 7, Article 6 of the Regulations Governing Pre-sale Procedures for Insurance Products.6.Product suitability policy, including at least the following:(1)The applicant understands fully that the premium he/she has paid is for purchasing an insurance product.(2)The type of insurance, insured amount and premium expense of the applicant are commensurate with his/her actual needs.(3)If the applicant purchases a foreign currency denominated insurance product, understand the applicant's exchange rate risk tolerance.(4)If the applicant wants to purchase an investment-linked insurance product, consider the applicant's suitability and risk tolerance, source of funding for payment of insurance premiums, and make sure that the applicant understands that he/she is at his/her own risk with regard to investment gain or loss from the investment-linked product, and do not offer the applicant any product that is beyond his/her financial means or unsuitable for the applicant.7.The obligation of a sales representative to fill out a solicitation report honestly, which shall include at least the following:(1) The course of solicitation;(2) The applicant and insured's annual income from work and other income;(3) Whether the applicant and insured have other commercial insurance and whether customers have terminated contracts, taken out loans, or taken out policy loans in the three months before purchasing the insurance.(4) The main sources of household income;(5) Whether the designated beneficiary in case of death of the insured is spouse, direct relative or heir apparent, and whether their order of succession and proportion of entitlement conform to related provisions of the Succession Law of the Civil Code; and if not, explain why;(6) For cases where the customer is over 65 years of age, the report shall state whether the customer has the ability to distinguish situations that are disadvantageous to his or her rights and interests as an insured, reasons why the insurance products is suitable for the customer, and evaluation record. However, the preceding provision does not apply if the characteristics of the insurance product are not found to have potential effects and disadvantages on customers over 65 years of age following an evaluation in accordance with Subparagraph 7, Article 6 of the Regulations Governing Pre-sale Procedures for Insurance Products.(7) Other information that will facilitate underwriting evaluation.8.An insurance enterprise or its sales representatives who solicit insurance business shall not engage in any of the following acts:(1) Solicit insurance business using people without the qualification of insurance solicitor.(2) Solicit business from an applicant or an insured by means of unfair discrimination, improper rebate, or any other inappropriate reduction of insurance premium.(3) Solicit business by means of exaggerated or false publicity or advertising, by making inappropriate comparison of the policies of different insurers, or by other inappropriate means.(4) Induce the customer to rescind or terminate contracts or pay the premium by a loan or a policy loan.(5) Solicit business using printed materials, advertising, introduction pamphlet, product description, recommendations and other materials that have not been consented or approved by the insurance enterprise.(6) Instigate the applicant or the insured to violate the obligation to inform, or use illicit means to instigate an applicant to cancel his/her policy, switch insurer, reduce the amount insured, pay up the premium, extend the policy, or obtain a policy loan.(7) The recipient of commission payment differs from the solicitor indicated in the insurance application.(8) Divert the use of premiums or embezzle the premiums.(9) Fail to identify the suitability of policy to the applicant or the insured, including providing customers over 65 years of age unsuitable insurance products.(10) Pay or collect remuneration in connection with improperly inducing customers to apply to the insurance enterprise for loans.(11) Engage in other practices that impair the rights and/or interests of the applicant, the insured or the beneficiary.9. An insurance enterprise shall ask insurance agents that solicit insurance business on its behalf and their sales representatives to observe the following provisions:(1) To comply with the Regulations Governing the Administration of Insurance Agents, Regulations Governing the Supervision of Insurance Solicitors and insurance agency contract signed with the insurance enterprise.(2) Aside from provisions on rewards and disciplines as provided in Subparagraph 1 of this paragraph and provisions on performance review linking commissions to risk exposure and duration of commission payment as provided in Subparagraph 2 of this paragraph, to comply with matters specified in Subparagraphs 1 ~ 8 of this paragraph and the insurance agency contract.10. When selling insurance products with surrender value (excluding small amount whole life insurance, group annuity insurance, and accident insurance with an insurance period of less than three years) to customers over 65 years of age, insurance enterprises shall, after obtaining the customer’s consent, maintain the record of selling process by audio or video means, or retain the trail of relevant operating process using electronic equipment. Appropriate unit or managerial personnel shall double-check such record or trail and confirm the product suitability for the customer. The methods for processing the aforementioned audio or video recording or records retained with electronic equipment shall be established by the Life Insurance Association of the Republic of China and such methods shall also be reported to the competent authority for recordation. However the preceding provision does not apply provided the insurance enterprise has established other measures for customer insurance rights protection and has reported those measures to the competent authority for recordation.11. Records of the sales process retained in audio or video recordings or records retained with electronic equipment according to the preceding subparagraph shall include at least the following items and they shall be kept for at least five years from the expiry of the insurance contract or five years from the date the decision of non-underwriting is finalized.(1) The soliciting sales representative must show his/her certified registration license and provide information on his/her company and his/her authorization to solicit insurance product.(2) Inform the customer of the name of the insurance product, name of the insurance company, the relationship between the solicitor and the insurance company, payment period, and payment amount.(3) Explain the contents of important provisions, exclusions, and contents of the recommendations.(4) Explain the customer’s right to rescind the contract.(5) Ask the customer whether the customer understands the amount of insurance premiums to be paid each year and verify whether the customer can afford the insurance premiums.(6) If the insurance product purchased by the customer is an investment-linked insurance product, the sales representative must explain the investment risks of the product, important contents of insurance product prospectus, related expenses for the insurance policy (including insurance cost), and the method of collection. He/she must also ask whether the customer understands the possible losses under less favorable conditions and confirm whether the customer can tolerate such losses.12.When a customer purchases an insurance product requiring policy value reserve (excluding small-amount whole-life insurance and accident insurance with an insurance period of less than three years), health insurance product, or mortgage life insurance product that pays survival benefits, the insurance enterprise shall observe the following provisions:(1)The insurance enterprise shall assign a staff from non-sales channels to conduct phone call, video call or remote interview to inform or confirm with the customer the following matters after the insurance contract is sold but before underwriting is approved. The insurance enterprise shall also save the phone interview recording or the audio or video recording of the video call or remote interview for future inspection, and safekeep the recording for at least five years after the expiry of the insurance contract or five years from the date the decision of not to underwrite the policy is finalized:a. Where the customer’s source of fund for premium payment is the termination of an insurance contract, loan or policy loan, the applicant and the actual premium payor should be confirmed or informed of the following matters:I. Confirmation of compliance with provisions specified in Subparagraph 5, Subparagraph 6, and Subparagraph 8.II. For customers whose source of funding for insurance premiums payment is a loan or a policy loan, the applicant and the actual premium payor must be clearly informed of related risks caused by the financial leverage operations and the maximum amount of potential losses.III. For customers whose source of funding for insurance premiums payment is the termination of a contract, the applicant and the actual premium payor must be clearly informed of related losses of interests in insurance contracts as a result of the insurance purchase after the termination of the contract.b. For customers over 65 years of age, the staff should ask questions gently around possible disadvantages of the insurance product the customer has purchased to confirm that the customer understands the potential effects and disadvantages on the customer associated with the characteristics of the insurance product. However the preceding provision does not apply if the characteristics of the insurance product are not found to have potential effects and disadvantages on customers over 65 years of age following an evaluation in accordance with Subparagraph 7, Article 6 of the Regulations Governing Pre-sale Procedures for Insurance Products, or if the insurance enterprise has established measures for customer insurance rights protection that meet the requirements set out in the proviso of Subparagraph 10 hereof.(2)If insurance brokers or insurance agents have conducted phone call, video call or remote interview of their customers in accordance with Article 33-1 of the Regulations Governing Insurance Brokers or Article 33-1 of the Regulations Governing Insurance Agents, insurance enterprises need not conduct phone call, video call or remote interview of such customers regarding the same matters in accordance with the preceding item.13. Other matters to be complied with as prescribed by the competent authority.An insurance enterprise shall ask insurance brokers it does business with to observe the following provisions:1.To comply with the Regulations Governing the Administration of Insurance Brokers and the contract signed with the insurance enterprise.2.May not introduce insurance products to applicants by offering premium discount or other illicit incentives.3.May not induce the customer to rescind or terminate contracts or use loans or policy loans to pay insurance premiums. Must understand whether the source of funding for the payment of insurance premiums is a terminated insurance contract, loan, or policy loan.4.May not engage in any practice that impairs the rights and/or interests of the applicant, the insured or the beneficiary.The provisions of Subparagraph 7, Paragraph 1 hereof do not apply to the solicitation of non-life insurance business.The content of solicitation report specified in Subparagraph 7, Paragraph 1 hereof does not apply to the solicitation of microinsurance business. Insurance companies may establish their own content based on their internal risk management considerations.An insurance enterprise that engages in wealth management business, and has established solicitation control measures for said business and reported the measures to the competent authority for recordation, or an insurance enterprise that has submitted the aforementioned measures along with its application for engaging in wealth management business to the competent authority and has obtained approval therefrom may conduct the business according to the following provisions:1. The provisions of Item (5) of Subparagraph 5, Subparagraph 10, Subparagraph 11, and Item (1).b of Subparagraph 12, Paragraph 1 hereof do not apply.2. The provisions of Item (4), Subparagraph 8 of Paragraph 1 hereof and Item (1), Subparagraph 12 of Paragraph 1 hereof do not apply when the insurance enterprise provides premium financing to its wealth management customers using the customer’s insurance contract as collateral.
中文原文 保險業招攬及核保理賠辦法第6條
保險業訂定其內部之業務招攬處理制度及程序,至少應包括並明定下列事項:
一、保險業從事保險招攬之業務人員資格、招攬險種、在職訓練、獎懲及權利義務,其中在職訓練包括保險業應要求業務人員每年參加公平對待六十五歲以上之客戶之相關教育訓練。
二、保險業從事保險招攬之業務人員酬金與承受風險及支給時間之連結考核,招攬品質、招攬糾紛等之管理。
三、保險業從事保險招攬之業務人員代收保險費之收費作業、送金單或收據之領用、收費時間及繳回等管理。
四、依行銷通路別及其特性訂定應遵行之事項。
五、保險業從事保險招攬之業務人員應充分瞭解要保人及被保險人之事項,其內容至少應包括:
(一)基本資料:1.要保人及被保險人之基本資料(至少應包括姓名、性別、出生年月日、身分證字號及聯絡方式;若為法人者,為法人之名稱、代表人、地址、聯絡電話);2.要保人與被保險人及被保險人與受益人之關係;3.若保險契約係以電子保單型式出單者,至少應取得要保人及被保險人之行動電話號碼、電子郵件信箱或其他經主管機關認可足資傳遞電子文件之聯絡方式;4.其他主管機關規定之基本資料。
(二)要保人及被保險人是否符合投保之條件。
(三)要保人及被保險人之投保目的及需求。
(四)繳交保險費之資金來源。
(五)評估六十五歲以上之客戶是否具有辨識不利其投保權益情形之能力。
但保險商品之特性經依保險商品銷售前程序作業準則第六條第七款規定評估不具潛在影響及各種不利因素者,不在此限。
六、保險商品適合度政策,其內容至少應包括:
(一)要保人已確實瞭解其所繳交保險費係用以購買保險商品。
(二)要保人投保險種、保險金額及保險費支出與其實際需求具相當性。
(三)要保人如係投保外幣收付之保險商品,應瞭解要保人對匯率風險之承受能力。
(四)要保人如係投保投資型保險商品,應考量要保人之投資屬性、風險承受能力、繳交保險費之資金來源,並確定要保人已確實瞭解投資型保險之投資損益係由其自行承擔,且不得提供逾越要保人財力狀況或不合適之商品。
七、保險業從事保險招攬之業務人員有誠實填寫招攬報告書之義務,其內容至少應包括:
(一)招攬經過。
(二)要保人及被保險人工作年收入及其他收入。
(三)要保人及被保險人是否投保其他商業保險,以及投保前三個月內客戶是否有辦理終止契約、貸款或保險單借款之情形。
(四)家中主要經濟來源者。
(五)身故受益人是否指定為配偶、直系親屬,或指定為法定繼承人,且其順位及應得比例適用民法繼承編相關規定。
若否,應說明原因。
(六)對六十五歲以上之客戶投保案件,應載明該客戶是否具有辨識不利其投保權益情形之能力、保險商品適合該客戶及評估理由,並做成評估紀錄。
但保險商品之特性經依保險商品銷售前程序作業準則第六條第七款規定評估不具潛在影響及各種不利因素者,不在此限。
(七)其他有利於核保之資訊。
八、保險業或其從事保險招攬之業務人員不得有下列情事:
(一)以未具保險業招攬人員資格者為招攬。
(二)對要保人或被保險人以錯價、放佣或其他不當折減保險費之方法為招攬。
(三)以誇大不實、引人錯誤之宣傳、廣告、以不同保險公司之契約內容作不當比較或其他不當之方法為招攬。
(四)勸誘客戶解除或終止契約,或以貸款、保險單借款繳交保險費。
(五)使用未經保險業同意之文宣、廣告、簡介、商品說明書及建議書等文書為招攬。
(六)慫恿要保人或被保險人違反告知義務或以不當之手段唆使要保人辦理退保、轉保、縮小保額、繳清、展期或貸款等行為。
(七)酬金支付對象與要保書所載招攬人員不同。
(八)挪用或侵占保險費。
(九)未確認要保人或被保險人對保單之適合度,包括對六十五歲以上之客戶提供不適合之保險商品。
(十)給付或支領因不當勸誘客戶向保險業申辦貸款之報酬。
(十一)其他損害要保人、被保險人或受益人權益之情事。
九、保險業應要求為其從事保險招攬之保險代理人及其業務員遵循下列事項:
(一)保險代理人管理規則、保險業務員管理規則之規定及保險代理合約之約定。
(二)除本項第一款之獎懲及第二款之酬金與承受風險及支給時間之連結考核等事項外,應依據本項第一款至第八款所列事項辦理,並明定於保險代理合約。
十、保險業銷售各種有解約金之保險商品(不包括小額終老保險、團體年金保險及保險期間在三年以下之傷害保險)予六十五歲以上之客戶,應經客戶同意後將銷售過程以錄音或錄影方式保留紀錄,或以電子設備留存相關作業過程之軌跡,並應由適當之單位或主管人員進行覆審,確認客戶辦理該等商品交易之適當性。
前揭錄音、錄影或以電子設備辦理之方式,由中華民國人壽保險商業同業公會訂定,並報主管機關備查。
但保險業另訂定其他客戶投保權益保障措施,並報經主管機關備查者,不在此限。
十一、前款銷售過程以錄音或錄影方式保留紀錄,或以電子設備留存相關作業過程之軌跡至少應包括下列事項,且應保存至保險契約期滿後五年或未承保確定之日起五年:
(一)招攬之業務員出示其合格登錄證,說明其所屬公司及獲授權招攬保險商品。
(二)告知客戶其購買之保險商品、保險公司名稱及招攬人員與保險公司之關係、繳費年期及繳費金額。
(三)說明商品重要條款內容、除外責任及建議書內容。
(四)說明契約撤銷之權利。
(五)詢問客戶是否瞭解每年必需繳交之保費,並確認客戶是否可負擔保費。
(六)客戶購買之保險商品如係投資型保險商品,並應說明商品之投資風險、保險商品說明書重要內容、保單相關費用(包括保險成本等保險費用)及其收取方式,以及詢問客戶是否瞭解在較差情境下之可能損失金額,並確認客戶是否可承受損失。
十二、保險業就客戶購買有保單價值準備金之保險商品(不包括小額終老保險、保險期間在三年以下之傷害保險)、健康保險商品或有生存保險金之房貸壽險商品者,應遵循下列規定:
(一)保險業應另指派非銷售通路之人員,於銷售保險契約後且同意承保前,再依下列事項進行電話訪問、視訊或遠距訪問,並應保留電話訪問錄音紀錄、視訊或遠距訪問錄音或錄影紀錄備供查核,且應保存至保險契約期滿後五年或未承保確定之日起五年:1.對於繳交保險費之資金來源為解約、貸款或保險單借款之要保人及實際繳交保險費之人,應確認或告知下列事項:(1)確認符合第五款、第六款及第八款所定事項。
(2)對於繳交保險費之資金來源為貸款或保險單借款之要保人及實際繳交保險費之人,向其明確告知其因財務槓桿操作方式所將面臨之相關風險,以及最大可能損失金額。
(3)對於繳交保險費之資金來源為解約之要保人及實際繳交保險費之人,向其明確告知其因終止契約後再投保所產生之保險契約相關權益損失情形。
2.對於年齡在六十五歲以上之客戶,應依客戶所購買保險商品不利於其投保權益之情形進行關懷提問,確認客戶瞭解保險商品特性對其之潛在影響及各種不利因素。
但保險商品之特性經依保險商品銷售前程序作業準則第六條第七款規定評估不具潛在影響及各種不利因素者,或保險業另訂定符合第十款但書規定之客戶投保權益保障措施者,不在此限。
(二)保險經紀人或保險代理人業依保險經紀人管理規則第三十三條之一或保險代理人管理規則第三十三條之一規定,對客戶辦理電話、視訊或遠距訪問之事項者,保險業免再依前目規定就相同事項進行電話、視訊或遠距訪問。
十三、其他主管機關規定應遵行之事項。
保險業應要求業務往來保險經紀人遵行下列事項:
一、符合保險經紀人管理規則之規定及業務往來合約之約定。
二、不得以保險費折讓或其他不當之誘因向要保人推介保險商品。
三、不得勸誘客戶解除或終止契約,或以貸款、保險單借款繳交保險費,並應瞭解繳交保險費之資金來源是否為解約、貸款或保險單借款。
四、不得有其他損害要保人、被保險人或受益人權益之情事。
第一項第七款之規定,於招攬財產保險時,得不適用。
第一項第七款所規定之招攬報告書內容,於招攬微型保險時得不適用,由保險業依其內部風險控管考量自行訂定。
保險業辦理財富管理業務,已訂定該業務之招攬控管措施,並報經主管機關備查,或保險業申請辦理財富管理業務時,已檢附該措施並經主管機關核准者,得依下列事項辦理:
一、不適用第一項第五款第五目、第十款、第十一款及第十二款第一目之2之規定。
二、保險業對財富管理客戶,以其保險契約為擔保辦理保費融資者,不適用第一項第八款第四目、第一項第十二款第一目之1之規定。

English translation for reference only; the Chinese text prevails. Not legal advice.