Regulations Governing Business Solicitation, Policy Underwriting and Claim Adjusting of Insurance Enterprises Article 7
The internal underwriting system and procedure of an insurance enterprise shall include and explicitly specify at least the following particulars:1. The qualifications, job descriptions, on-the-job training and reward/discipline of underwriters. On-the-job training includes the insurance enterprises requiring underwriters to attend annual training on fair treatment of customers over 65 years of age.2. Procedure and flow chart covering the process from acceptance of application to agreeing to underwrite a policy, including at least underwriting guidelines, financial underwriting mechanism, survival analysis and physical examination standards, insurance reporting mechanism, hierarchy of authority, and arrangement of reinsurance.3. The policy of understanding and evaluating the needs and suitability of the applicant and the insured:(1) Make sure the applicant understands fully that the premium he/she has paid is for purchasing an insurance product.(2) Evaluate that 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, applicant's exchange rate risk tolerance has been evaluated.(4) If the applicant wants to purchase an investment- linked insurance product, an insurance enterprise shall comply with the following provisions:I. The applicant's suitability, risk tolerance and source of funding for payment of insurance premiums have been evaluated, and the fact that the applicant understands that he/she is at his/her own risk with regard to the investment gain or loss from the investment-linked product has been evaluated.II. The applicant may not be offered any product that is beyond his/her financial means or unsuitable for him/her.III. An insurance enterprise may not undertake insurance policies if the applicant’s investment attribute is evaluated as non-active and the insurance premiums are paid with a loan or policy loan.4.The operating procedure for evaluating whether the insured amount and premium payment are commensurate with the income, financial situations and occupation of the applicant or the insured. But for life insurance, accident insurance and travel insurance over certain insured amount, the operating procedure for verifying whether information or documentation on the income, financial situation and occupation of the applicant or the insured is reasonable and credible, and whether such information is commensurate with the insured amount or premium payment.5. The operating procedure for evaluating the suitability of 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 and considering whether the customer has the ability to distinguish situations that are disadvantageous to his or her rights and interests as an insured.6.The operating procedure for evaluating whether the sources of funding for payment of insurance premiums is from a terminated insurance contract, loan, or policy loan, including mechanisms for inspecting whether the customer has terminated a contract with the same insurance enterprise or another insurance enterprise, or has taken out a loan or policy loan with the same insurance enterprise in the three months prior to the purchase of the insurance policy and before underwriting is approved, and whether related financial information provided by the customer in transactions with the insurance enterprise are consistent. However, the preceding provision does not apply if the terminated insurance contract is a microinsurance, group insurance or accident insurance with an insurance period of less than three years.7.The operating procedure for confirming the identity of the applicant and that he/she has indeed purchased a policy, the identity of the insured and that the insured has given his/her consent to the policy purchased.8.The operating procedure for confirming that the designation or change of beneficiary has been consented by the insured.9. The operating procedure for confirming that the applicant has indeed applied for changing the content of the insurance contract that would affect risk assessment, and the identity and signature of the applicant and the insured.10. The operating procedure for the manner and duration of retaining and disposing the personal data of the applicant, the insured and the beneficiary of applications that were underwritten and not underwritten.11.The operating procedure for evaluating risks and the calculation and collection of insurance premiums shall be based on actuarial science and statistical data. The insurance enterprise may not treat a specific applicant or policyholder unfairly because of his or her disability.12.The following situations are prohibited:(1) Underwriting work is performed by someone without the qualification of underwriter.(2) Reviewing and underwriting an application without considering the content of the insurance product and suitability.(3) Underwriting a policy by validating the policy retroactively; the preceding provision does not apply if it is otherwise provided in accordance with international customary practice, the procurement or service contract executed under the Government Procurement Act, or other laws.(4) Failing to faithfully review the signatures, endorsement or information affixed/provided by the applicant or the insured and the insurance solicitor or other relevant evidence indicating willingness on the part of the applicant in accordance with relevant laws and regulations. If the business of an insurance agent or broker is solicited by its sales representative, the application is not signed by the sales representative or endorsed by a qualified insurance agent or broker.(5) Failing to faithfully implement the procedure of reviewing the finance of the applicant or the insured, the insurance reporting mechanism or the suitability policy or failing to retain documentation on the implementation of insurance reporting and inquiry mechanism, and retain the underwriting evaluation documents.(6) Failing to understand whether the source of funding for payment of insurance premiums is a terminated contract, loan, or policy loan and evaluate its appropriateness.(7) Engaging in other practices that impair the rights and/or interests of the applicant, the insured or the beneficiary.13. Other matters to be complied with as prescribed by the competent authority.The provisions on financial underwriting mechanism and survival analysis and physical examination standards mentioned in Subparagraph 2 of the preceding paragraph and the provisions in Subparagraphs 4 ~ 9 of the preceding paragraph do not apply to non-life insurance products, microinsurance products and other specific insurance products.Insurance enterprises shall submit the financial underwriting mechanism and survival analysis and physical examination standards drafted in accordance with Subparagraph 2, Paragraph 1 hereof, the policy of evaluating the needs and suitability of the applicant and the insured mentioned in Subparagraph 3 of this paragraph and operating procedures mentioned in Subparagraphs 4 ~ 9 of this paragraph to the competent authority for recordation.The term insurance reporting mechanism referred to in Paragraph 1 connotes reports of specific data of insurance contracts by the insurance enterprise to the insurance business reporting and information system when applications are accepted, agreement to underwrite a policy is indicated, or the insurance contract status has been modified. Relevant data of the applicant and insured stored in the system may be accessed and retrieved as a reference for the underwriting process and underwriting decisions.The procedure for retaining personal data of applications that were not underwritten under Subparagraph 10 of Paragraph 1 hereof shall comply with the following provisions:1. The retention period shall not exceed five years from the date the decision of non-underwriting is finalized, unless a longer period is otherwise required by law. When the retention period for the data of a non-underwritten application case expires but the case is involved in a complaint, mediation or litigation proceeding that there is an ongoing need to process and use data of the case, such data may be retained until one year has elapsed since the date the dispute resolution proceeding is concluded.2. An insurance enterprise shall process and use the personal data of applications that were not underwritten in accordance with the Personal Information Protection Act and delete, and stop to process or use such data after its retention period expires.The provisions of Subparagraph 4 and Subparagraph 5 of Paragraph 1 hereof do not apply if the insurance enterprise engages in wealth management business, and has established underwriting control measures for said business and reported the measures to the competent authority for recordation, or if the insurance enterprise has submitted the aforementioned measures along with its application for engaging in wealth management business to the competent authority and has obtained approval therefrom.
中文原文 保險業招攬及核保理賠辦法第7條
保險業訂定其內部之核保處理制度及程序，至少應包括並明定下列事項：
一、聘用核保人員之資格、職掌範圍、在職訓練及獎懲，其中在職訓練包括保險業應要求核保人員每年參加公平對待六十五歲以上客戶之相關教育訓練。
二、受理要保書至同意承保出單之程序及流程圖，其中至少應包括核保準則、財務核保機制、生調體檢標準、保險通報機制、分層負責授權權限、再保險安排等。
三、瞭解並評估要保人與被保險人保險需求及適合度之政策：
（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）評估要保人投保險種、保險金額及保險費支出與其實際需求已具相當性。
（三）要保人如係投保外幣收付之保險商品，已評估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，應遵循下列事項：1.已評估要保人之投資屬性、風險承受能力、繳交保險費之資金來源，並已評估要保人確實瞭解投資型保險之投資損益係由其自行承擔。
2.不得提供逾越要保人財力狀況或不合適之商品。
3.不得承保要保人投資屬性經評估非為積極型且以貸款或保險單借款繳交保險費者之保件。
四、評估保險金額、保險費與要保人或被保險人收入、財務狀況與職業等間具相當性之作業程序。
但對於一定保險金額以上之人壽保險、傷害保險及旅行平安保險，則應落實查證要保人或被保險人收入、財務狀況及職業等之資訊或文件是否合理可信，以及其與保險金額或保險費具相當性。
五、評估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）予六十五歲以上客戶之適當性，並應考量客戶是否具有辨識不利其投保權益情形之能力。
六、評估繳交保險費之資金來源是否為解約、貸款或保險單借款之作業程序，包括檢核客戶，其投保前三個月及同意承保前是否向同一保險業或其他同業辦理終止契約、同一保險業辦理貸款或保險單借款；以及客戶與該保險業往來交易所提供相關財務資訊具一致性之機制。
但終止之保險契約為微型保險、團體保險、保險期間在三年以下之傷害保險者，不在此限。
七、確認要保人身分與其確有投保、被保險人身分與其確有同意之作業程序。
八、確認受益人之指定或變更經被保險人同意之作業程序。
九、確認要保人有申請影響危險評估之保險契約內容變更，以及要保人與被保險人身分及簽章之作業程序。
十、保存承保件及未承保件要保人、被保險人與受益人個人資料之方式、保存期限及銷毀之作業程序。
十一、評估風險及計收保費應基於保險精算及統計資料作為危險估計之基礎，且不得對特定承保對象，或僅因被保險人為身心障礙者而有不公平待遇。
十二、不得有下列情事：
（一）未具核保人員之資格執行核保簽署作業。
（二）未依保險商品內容予以評估適合度並簽署承保。
（三）以保單追溯生效方式承保。
但依國際慣例、政府採購法採購或招標之契約或法律另有規定者，不在此限。
（四）未確實審閱要保人或被保險人及保險業招攬人員之簽章、簽署或其他法令規定足資證明要保人投保意願之相關證據或填報內容。
保險代理人公司或保險經紀人公司之業務，係由其所屬保險業務員招攬者，保險業務員未於要保書上簽章。
（五）未落實要保人或被保險人財務核保程序、保險通報機制或適合度政策，或未保留執行保險通報查詢機制相關書面及核保評估文件。
（六）未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，並評估其適當性。
（七）其他損害要保人、被保險人或受益人權益之情事。
十三、其他主管機關規定應遵行之事項。
前項第二款有關財務核保機制、生調體檢標準及第四款至第九款，得不適用於財產保險商品、微型保險商品及其他特定保險商品。
保險業依據第一項第二款所訂之財務核保機制與生調體檢標準、第三款評估要保人與被保險人保險需求及保險適合度政策，以及第四款至第九款之作業程序應報主管機關備查。
第一項所稱保險通報機制，係指保險業於受理要保書、同意承保出單及保險契約狀態有異動時，報送保險契約之特定資料至保險業通報作業資訊系統，並於執行核保作業時至該系統查詢要保人及被保險人之相關資訊，以作為作成核保決定之參考。
第一項第十款對於未承保件個人資料之保存程序，應符合下列規定：
一、保存期限不得逾未承保確定之日起五年。
但法令另有較長保存期限之規定者，從其規定。
前開未承保資料保存期限屆滿，因處理申訴、調解及訴訟等程序，而有繼續處理及利用前開個人資料之需求者，得續予保存至該等爭議處理終結之日起一年。
二、保險業應依個人資料保護法相關規定處理及利用前開未承保件個人資料，並於保存期限屆滿後刪除、停止處理或利用該個人資料。
保險業辦理財富管理業務，已訂定該業務之核保控管措施，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，不適用第一項第四款、第五款之規定。
一、聘用核保人員之資格、職掌範圍、在職訓練及獎懲，其中在職訓練包括保險業應要求核保人員每年參加公平對待六十五歲以上客戶之相關教育訓練。
二、受理要保書至同意承保出單之程序及流程圖，其中至少應包括核保準則、財務核保機制、生調體檢標準、保險通報機制、分層負責授權權限、再保險安排等。
三、瞭解並評估要保人與被保險人保險需求及適合度之政策：
（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）評估要保人投保險種、保險金額及保險費支出與其實際需求已具相當性。
（三）要保人如係投保外幣收付之保險商品，已評估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，應遵循下列事項：1.已評估要保人之投資屬性、風險承受能力、繳交保險費之資金來源，並已評估要保人確實瞭解投資型保險之投資損益係由其自行承擔。
2.不得提供逾越要保人財力狀況或不合適之商品。
3.不得承保要保人投資屬性經評估非為積極型且以貸款或保險單借款繳交保險費者之保件。
四、評估保險金額、保險費與要保人或被保險人收入、財務狀況與職業等間具相當性之作業程序。
但對於一定保險金額以上之人壽保險、傷害保險及旅行平安保險，則應落實查證要保人或被保險人收入、財務狀況及職業等之資訊或文件是否合理可信，以及其與保險金額或保險費具相當性。
五、評估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）予六十五歲以上客戶之適當性，並應考量客戶是否具有辨識不利其投保權益情形之能力。
六、評估繳交保險費之資金來源是否為解約、貸款或保險單借款之作業程序，包括檢核客戶，其投保前三個月及同意承保前是否向同一保險業或其他同業辦理終止契約、同一保險業辦理貸款或保險單借款；以及客戶與該保險業往來交易所提供相關財務資訊具一致性之機制。
但終止之保險契約為微型保險、團體保險、保險期間在三年以下之傷害保險者，不在此限。
七、確認要保人身分與其確有投保、被保險人身分與其確有同意之作業程序。
八、確認受益人之指定或變更經被保險人同意之作業程序。
九、確認要保人有申請影響危險評估之保險契約內容變更，以及要保人與被保險人身分及簽章之作業程序。
十、保存承保件及未承保件要保人、被保險人與受益人個人資料之方式、保存期限及銷毀之作業程序。
十一、評估風險及計收保費應基於保險精算及統計資料作為危險估計之基礎，且不得對特定承保對象，或僅因被保險人為身心障礙者而有不公平待遇。
十二、不得有下列情事：
（一）未具核保人員之資格執行核保簽署作業。
（二）未依保險商品內容予以評估適合度並簽署承保。
（三）以保單追溯生效方式承保。
但依國際慣例、政府採購法採購或招標之契約或法律另有規定者，不在此限。
（四）未確實審閱要保人或被保險人及保險業招攬人員之簽章、簽署或其他法令規定足資證明要保人投保意願之相關證據或填報內容。
保險代理人公司或保險經紀人公司之業務，係由其所屬保險業務員招攬者，保險業務員未於要保書上簽章。
（五）未落實要保人或被保險人財務核保程序、保險通報機制或適合度政策，或未保留執行保險通報查詢機制相關書面及核保評估文件。
（六）未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，並評估其適當性。
（七）其他損害要保人、被保險人或受益人權益之情事。
十三、其他主管機關規定應遵行之事項。
前項第二款有關財務核保機制、生調體檢標準及第四款至第九款，得不適用於財產保險商品、微型保險商品及其他特定保險商品。
保險業依據第一項第二款所訂之財務核保機制與生調體檢標準、第三款評估要保人與被保險人保險需求及保險適合度政策，以及第四款至第九款之作業程序應報主管機關備查。
第一項所稱保險通報機制，係指保險業於受理要保書、同意承保出單及保險契約狀態有異動時，報送保險契約之特定資料至保險業通報作業資訊系統，並於執行核保作業時至該系統查詢要保人及被保險人之相關資訊，以作為作成核保決定之參考。
第一項第十款對於未承保件個人資料之保存程序，應符合下列規定：
一、保存期限不得逾未承保確定之日起五年。
但法令另有較長保存期限之規定者，從其規定。
前開未承保資料保存期限屆滿，因處理申訴、調解及訴訟等程序，而有繼續處理及利用前開個人資料之需求者，得續予保存至該等爭議處理終結之日起一年。
二、保險業應依個人資料保護法相關規定處理及利用前開未承保件個人資料，並於保存期限屆滿後刪除、停止處理或利用該個人資料。
保險業辦理財富管理業務，已訂定該業務之核保控管措施，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，不適用第一項第四款、第五款之規定。