14640TM Pru - Life claim report Jan-Jun 2016-v18 Aug26 · Cover and Disability Claims were greater...
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2016 Individual Life Claims Report (January 2016 - June 2016) 個人壽險理賠報告（2016年1月至2016年6月） The total claims payout for January to June 2016 was more than HKD 1.1 billion. In comparison, the first half year of 2016 accounted for 61% of the total claims payout for the full year of 2015. 於2016年1月至6月，我們賠付的總額超過11億港元。2016年首半年度之理賠金額佔2015全年的賠付總額61%。 * Including Cancer Protector Plans and PRUhealth Medical Plus / 包括癌症全護計劃及醫療加倍保 For Internal Use Only 只供內部使用 * Including Cancer Protector Plans and PRUhealth Medical Plus / 包括癌症全護計劃及醫療加倍保 From January to June 2016, Death, Accident and Other Medical Plan claims had a settlement rate greater than 90%. The settlement rate for Crisis Cover and Disability Claims were greater than 80% and the settlement rate for PPM Plans claims was 72%. 於2016年1月至6月，身故、意外及其它醫療保險計劃的成功理賠百份比均超過90%。危疾及傷殘保障理賠的成功理賠百份比超過80%， 而「摯為您」優悅醫療保險計劃的成功理賠百份比則為72%。 CLAIMS SUMMARY 理賠總結 PERCENTAGE OF SUCCESSFUL CLAIMS 理賠的成功百份比 Jan - June 2016 Claims Summary 2016年1月至2016年6月之理賠個案總數概覽表 Jan - Jun 2016 Claims Summary 2016年1月至2016年6月之理賠金額概覽表 Claims Types Total No. of Total No. of Percentage of Processed Claim Case Successful Claim Case Successful Claims 理賠類別 處理理賠個案總數 成功理賠個案總數 成功理賠百份比 Death 身故 773 745 96% Crisis Cover 危疾 781 664 85% Disability 傷殘保障 291 241 83% Hospitalisation - PPM Plans 3,463 2,497 72% 住院 - 「摯為您」優悅醫療保險計劃 Hospitalisation - Other Medical Plans* 39,902 36,961 93% 住院 - 其它醫療保險計劃 Accident 意外 3,141 3,041 97% Total 總數 48,351 44,149 91% Claims Type 2014 Full Year/全年 2015 Full Year/全年 1/2016 - 6/2016 理賠類別 (HKD Million/百萬港元) (HKD Million/百萬港元) (HKD Million/百萬港元) Death 身故 $372 $509 $261 Crisis Cover 危疾 $490 $503 $300 Disability 傷殘保障 $4 $5 $2 Hospitalisation - PPM Plans $17 $34 $26 住院 - 「摯為您」優悅醫療保險計劃 Hospitalisation - Other Medical Plans* $703 $789 $530 住院 - 其它醫療保險計劃 Accident 意外 $39 $44 $22 Total 總數 $1,625 $1,884 $1,141 Year to Year Growth 年度增長 27% 16% -
Transcript of 14640TM Pru - Life claim report Jan-Jun 2016-v18 Aug26 · Cover and Disability Claims were greater...
2016 Individual Life Claims Report (January 2016 - June 2016)
個人壽險理賠報告（2016年1月至2016年6月）
The total claims payout for January to June 2016 was more than HKD 1.1 billion. In comparison, the first half year of 2016 accounted for 61% of the total claims payout for the full year of 2015.於2016年1月至6月，我們賠付的總額超過11億港元。2016年首半年度之理賠金額佔2015全年的賠付總額61%。
*Including Cancer Protector Plans and PRUhealth Medical Plus / 包括癌症全護計劃及醫療加倍保
For Internal Use Only只供內部使用
*Including Cancer Protector Plans and PRUhealth Medical Plus / 包括癌症全護計劃及醫療加倍保
From January to June 2016, Death, Accident and Other Medical Plan claims had a settlement rate greater than 90%. The settlement rate for Crisis Cover and Disability Claims were greater than 80% and the settlement rate for PPM Plans claims was 72%. 於2016年1月至6月，身故、意外及其它醫療保險計劃的成功理賠百份比均超過90%。危疾及傷殘保障理賠的成功理賠百份比超過80%，而「摯為您」優悅醫療保險計劃的成功理賠百份比則為72%。
CLAIMS SUMMARY 理賠總結
PERCENTAGE OF SUCCESSFUL CLAIMS理賠的成功百份比
Jan - June 2016 Claims Summary2016年1月至2016年6月之理賠個案總數概覽表
Jan - Jun 2016 Claims Summary2016年1月至2016年6月之理賠金額概覽表
Claims Types Total No. of Total No. of Percentage of Processed Claim Case Successful Claim Case Successful Claims理賠類別 處理理賠個案總數 成功理賠個案總數 成功理賠百份比
Death 身故 773 745 96%
Crisis Cover 危疾 781 664 85%
Disability 傷殘保障 291 241 83%
Hospitalisation - PPM Plans 3,463 2,497 72%住院 -「摯為您」優悅醫療保險計劃
Hospitalisation - Other Medical Plans* 39,902 36,961 93%住院 - 其它醫療保險計劃
Accident 意外 3,141 3,041 97%
Total 總數 48,351 44,149 91%
Claims Type 2014 Full Year/全年 2015 Full Year/全年 1/2016 - 6/2016理賠類別 (HKD Million/百萬港元) (HKD Million/百萬港元) (HKD Million/百萬港元)
Death 身故 $372 $509 $261
Crisis Cover 危疾 $490 $503 $300
Disability 傷殘保障 $4 $5 $2
Hospitalisation - PPM Plans $17 $34 $26住院 -「摯為您」優悅醫療保險計劃
Hospitalisation - Other Medical Plans* $703 $789 $530住院 - 其它醫療保險計劃
Accident 意外 $39 $44 $22
Total 總數 $1,625 $1,884 $1,141
Year to Year Growth 年度增長 27% 16% -
DEATH CLAIMS身故理賠
Cancer, Circulatory System Disease and Respiratory System Disease were the top 3 causes of Death Claims. 73% of the total no. of Death Claims were attributed to these causes.癌症、循環系統疾病及呼吸系統疾病是身故理賠中三大主要的常見原因，共佔身故理賠總個案數目73%。
Causes of Death Claims身故理賠原因
Death Claims by Age and Sex身故理賠年齡及性別分析圖表
From January to June 2016, the highest number of Death Claims was in the age group of 51 to 60. Among this age group, the total no. of Male Death Claims is 4% more than Female Death Claims.於2016年1月至6月，最多身故理賠個案的年齡組別為51至60歲。在此年齡組別，男性總數目比女性總數目高4%。
No. of Case 數目
0-10 11- 20 21-30 31-40 41-50 51-60 61-70 71-80 81-90 91-100
Age Group 年齡組別
0
20
40
60
80
100Male 男性
Female 女性
Age Group Female Male No. of Case Percentage年齡組別 女性 男性 理賠數目 百分比
0 - 10 6 2 8 1.1%
11 - 20 2 3 5 0.7%
21 - 30 2 18 20 2.7%
31 - 40 26 33 59 7.9%
41 - 50 87 57 144 19.3%
51 - 60 90 94 184 24.7%
61 - 70 101 63 164 22.0%
71 - 80 56 43 99 13.3%
81 - 90 25 29 54 7.2%
91 - 100 7 1 8 1.1%
Total 總和 402 343 745 100%
Types of Cancer in Death Claims身故理賠癌症類別
Types of Cancer No. of Case Percentage癌症類別 理賠數目 百分比
Respiratory System (Nasopharynx, Trachea, Bronchus and Lung) 117 34.0%呼吸系統（鼻咽、氣管、支氣管及肺）
Digestive System (Esophagus, Stomach,Gallbladder, Liver, Pancreas, Colon, Rectum) 消化系統（食管、胃、膽囊、肝、胰、
105 30.5%
結腸及直腸）
Female Reproductive System (Breast, Ovary,Corpus Uteri and Cervix Uteri ) 66 19.2%女性生殖系統（乳房、卵巢、子宮體及宮頸）
Blood and Immune System (Leukaemia,Lymphoma, Myeloma) 10 2.9%血液及淋巴系統（白血病、淋巴腺癌及骨髓癌）
Urinary System (Kidney and Bladder)泌尿系統（腎及膀胱）
10 2.9%
Male Reproductive System (Prostate and Testis)男性生殖系統（前列腺及睪丸） 4 1.2%
Others 其他 32 9.3%
Total 總和 344 100%
Causes of Death Claims No. of Case Percentage身故理賠類別 理賠數目 百分比
Cancer 癌症 344 46.2%
Circulatory System Disease 循環系統疾病 126 16.9%
Respiratory System Disease 呼吸系統疾病 72 9.7%
Suicide自殺 40 5.3%
Nervous System & Sense Organ Disorders 神經系統和感覺器官疾病 37 5.0%
Infectious & Parasitic Diseases傳染病和寄生蟲疾病 30 4.0%
Genitourinary System Disease泌尿生殖系統疾病 25 3.3%
Digestive System Disease 消化系統疾病 23 3.1%
Injuries & Adverse Effects損傷及後遺症 23 3.1%
Endocrine, Nutritional & Metabolic Disorders 內分泌，營養和代謝疾病 8 1.1%
Blood and Blood-Forming Organs Disorders 血液及造血器官疾病 7 0.9%
Sudden Death猝死 5 0.7%
Others 其他 5 0.7%
Total 總和 745 100%
Cancer, Heart Disease and Carcinoma-in-situ were the top 3 causes of Crisis Cover Claims. More than 86% of the total no. of Crisis Cover Claims were attributed to these causes. 癌症、心臟疾病及原位癌是危疾理賠中三大主要的常見原因，共佔危疾理賠總個案數目超過86%。
CRISIS COVER CLAIMS危疾理賠
Causes of Crisis Cover Claims危疾理賠原因
From January to June 2016, the highest number of Crisis Cover Claims was in the age group of 51 to 60. Among this age group, Females accounted for more than 58% of the total number of Crisis Cover Claims.於2016年1月至6月，最多危疾理賠個案的年齡組別為51至60歲。在此年齡組別，女性總數目佔總危疾理賠個案之58%。
Crisis Cover Claims by Age and Sex危疾理賠年齡及性別分析圖表
Age Group Female Male No. of Case Percentage年齡組別 女性 男性 理賠數目 百分比
0 - 10 3 4 7 1.1%
11 - 20 0 2 2 0.3%
21 - 30 11 8 19 2.8%
31 - 40 96 37 133 20.0%
41 - 50 153 66 219 33.0%
51 - 60 138 99 237 35.7%
61 - 70 32 12 44 6.6%
71 - 80 2 1 3 0.5%
Total 總和 435 229 664 100%
Types of Cancer in Crisis Cover Claims危疾理賠癌症類別
Causes of Crisis Cover Claims No. of Case Percentage危疾理賠類別 理賠數目 百分比
Cancer 癌症
476 71.7%
Heart Disease心臟疾病
69 10.4%
Carcinoma-in-situ原位癌 31 4.7%
Brain Surgery腦部外科手術
31 4.7%
Stroke中風 25 3.8%
Benign Brain Tumor良性腦腫瘤 8 1.2%
Kidney Failure 腎衰竭 4 0.6%
Alzheimer's Disease阿滋海默症 3 0.5%
Loss of Independent Existence不能獨立生活 3 0.5%
Total and Permanent Disability完全及永久傷殘 3 0.5%
Others 其他 11 1.4%
Total 總和 664 100%
No. of Case 數目
0-10 11- 20 21-30 31-40 41-50 51-60 61-70 71-80
Age Group 年齡組別
0
50
100
150Male 男性
Female 女性
Types of Cancer No. of Case Percentage癌症類別 理賠數目 百分比
Female Reproductive System (Breast, Ovary, Corpus Uteri and Cervix Uteri) 189 39.7%女性生殖系統（乳房、卵巢、子宮體及宮頸）
Digestive System (Esophagus, Stomach,Gallbladder, Liver, Pancreas, Colon, Rectum) 消化系統（食管、胃、膽囊、肝、胰、 81 17.0%
結腸及直腸）
Respiratory System (Nasopharynx, Trachea, Bronchus and Lung) 76 16.0%呼吸系統（鼻咽、氣管、支氣管及肺）
Blood and Immune Systm (Leukaemia,Lymphoma, Myeloma) 42 8.8%血液及淋巴系統（白血病、淋巴腺癌及骨髓癌）
Thyroid Gland甲狀腺
38 8.0%
Musculoskeletal & Connective Tissue肌肉骨骼系統及結締組織
12 2.5%
Male Reproductive System (Prostate and Testis)男性生殖系統（前列腺及睪丸）
8 1.7%
Urinary System (Kidney and Bladder) 泌尿系統（腎及膀胱）
5 1.1%
Others 其他 25 5.2%
Total 總和 476 100%
HOSPITALISATION CLAIMS住院理賠
Overview of Hospitalisation Claims住院理賠總覽
*Including Cancer Protector Plans and PRUhealth Medical Plus / 包括癌症全護計劃及醫療加倍保
Medical Reimbursement - Medical Reimbursement - Hospital and Surgical Cash Claims PPM Plans Other Medical Plans*
住院及手術現金理賠 醫療費用理賠 - 醫療費用理賠 - 「摯為您」優悅醫療保險計劃 其它醫療保險計劃
Total Claim No. 總理賠數目 14,073 2,497 22,888
Total Paid Amount (HKD Million) 總理賠金額（百萬港元）
$46 $26 $484
Digestive System, Respiratory System and Injuries & Adverse Effects were the top 3 causes of Hospitalisation Claims. They contributed to 50% of the total no. of Hospitalisation Claims from January to June 2016.於2016年1月至6月的住院理賠中，消化系統疾病、呼吸系統疾病及損傷及後遺症為三大住院的主要原因，共佔住院理賠總個案數目的50%。
Causes of Hospitalisation Claims住院理賠原因
Hospitalisation Claims by Age and Sex住院理賠年齡及性別分析圖表
From January to June 2016, the highest number of Hospitalisation Claims was in the age group of 31-40. Among this age group, Females accounted for 59% of the total number of Hospitalisation Claims.
於2016年1月至6月，最多住院理賠個案的年齡組別為31至40歲。在此年齡組別，女性的住院理賠個案佔總住院理賠數目之59%。
Causes of Hospitalisation Claims Grand Total Percentage 住院理賠原因 個案總數 百分比
Digestive System 消化系統疾病 8,846 22.4%
Respiratory System 呼吸系統疾病 6,255 15.9%
Injuries & Adverse Effects 損傷及後遺症 4,675 11.8%
Neoplasms 腫瘤 3,797 9.6%
Genitourinary System 泌尿生殖系統疾病 3,029 7.7%
Circulatory System 循環系統疾病 2,904 7.4%
Nervous System & Sense Organ Disorders 神經系統及感覺器官疾病 2,647 6.7%
Musculoskeletal & Connective Tissue Diseases 肌肉骨骼系統及結締組織疾病 2,322 5.9%
Infectious & Parasitic Diseases 傳染病和寄生蟲疾病 2,258 5.7%
Skin, Subcutaneous Tissue Diseases 皮膚及皮下組織疾病 1,297 3.3%
Endocrine, Nutritional & Metabolic Disorders 內分泌，營養和代謝疾病 629 1.6%
Abnormal Pregnancy 異常妊娠 333 0.8%
Blood and Blood-Forming Organs Disorders 血液及造血器官疾病 272 0.7%
Others 其他 194 0.5%
Total 總和 39,458 100%
Age Group Female Male No. of Case Percentage年齡組別 女性 男性 理賠數目 百分比
0-10 3,202 4,270 7,472 18.9%
11-20 597 737 1,334 3.4%
21-30 2,546 1,739 4,285 10.9%
31-40 5,390 3,785 9,175 23.3%
41-50 5,074 3,718 8,792 22.3%
51-60 3,205 2,414 5,619 14.2%
61-70 1,317 1,068 2,385 6.0%
71-80 191 167 358 0.9%
81-90 14 24 38 0.1%
Total 總和 21,536 17,922 39,458 100%
No. of Case 數目
0-10 11- 20 21-30 31-40 41-50 51-60 61-70 71-80 81-90Age Group 年齡組別
0
1,000
2,000
3,000
6,000
5,000
4,000
Male 男性
Female 女性
