Study On The Legal Relations Of The Commercial Health Insurance

A basic principle of social medical insurance in our country is low-level, widecoverage, the basic, multi-level, sustainable, so it is doomed that the level of socialmedical insurance in our country is quite low. the phenomenon of " poverty caused byillness，because of illness back to poor" is still serious, therefore, the governmentbegins to promote the construction of the system of medical treatment of a seriousillness."System of medical treatment of a serious illness" clearly points out that weshould set up multi-level medical security system by introducting the marketmechanism and using of commercial health insurance professional advantages, whichpoints out the direction for the integration of commercial health insurance and socialmedical insurance development, and for the development of commercial healthinsurance under the background of new healthcare reform.The development of commercial health insurance in China started relatively late.all aspects of the system is not perfect and there are many problems. Under thebackground of the new health care reform, as an opportunity to participate in socialmedical insurance, commercial health insurance is ushered in the challenge and in thedevelopment opportunity. This paper tries to analyze the main legal relationshipexisting in the commercial health insurance and social medical insurance and provideconstructive Suggestions for the development of commercial medical insurance.However, in the current situation in our country, the legal relations of the commercialhealth insurance is too complex, so, this paper mainly discusses four aspects of themain legal relationship. Two basic relations of insurance contract relationship andInsurance trust relationship, as well as the relations behind the two kinds, theunderwriter, policy-holder and medical institutions of the tripartite relations andinsurance regulatory relationship.Insurance contract relationship mainly adjusts the relationship between thepolicy-holder and the insurer, which is also the main legal relationship in theinsurance contract. Under the background of the new reform, commercial health insurance contract relations, has a certain particularity, and there was a generalcharacteristic of the insurance contract. Because of the particularity of commercialhealth insurance, the incidence of the moral hazard is great at the time of theconclusion of the contract, combined with business matters covered by the healthinsurance and social medical insurance range overlap, these are not conducive to thedevelopment of commercial health insurance. Therefore, to perfect the informobligation of the underwriter and policy-holder demonstrative obligation and tospecific commercial health insurance and social medical insurance become a keydistinction.Insurance commission relationship is a kind of special relationship under thebackground of the new health care reform which is commercial health insurance toparticipate in social medical insurance, the government by buying services letcommercial health insurance involve in social medical insurance. In commissionedrelations, both sides have great benefits, but there are also related to entrust theorgnaization of business health insurance of social medical insurance system is notsound, entrusted with low level issues.In the ralitionship of the underwriter, policy-holder and medical institutions, it isneed to clear the relationship between the three, because now the problems is:medical service provider does not stand on one side, the interests of the insurer is noton the applicant side，So it greatly increases the moral hazard of medical treatmentservice and increases the cost of the commercial health insurance. Therefore, how todeal with the relationship between medical service providers and the underwriter,policy-holder is the key to the development of commercial medical insurance.Insurance regulation relationship is the main Insurance law relationship，which isthe guarantee of healthy development of the commercial health insurance. Under thebackground of the reform, since there is the model of business health insurancehandling social medical insurance, so there should be corresponding regulatory model.However, there is no regulatory model of the hand, can’t escort for the orgnaization ofcommercial health insurance of social medical insurance.All in all, this paper will on the basis of analyzing the main legal relationship, ofwhich some of the problems, trying to find the answer and put forward some own views.