Severe disease expands to 28 types of mild disease definition introduced for the first time
The new regulations of critical illness insurance have a profound impact on the industry
Economic Daily · China Economic Net reporter Yu Yong Li Chenyang
This revision of the critical illness insurance regulations introduces the definition of mild disease for the first time. The three core diseases, malignant tumor, acute myocardial infarction, and stroke sequelae, are classified into severe and mild diseases according to their severity.
In addition, from the perspective of protecting the interests of consumers, this revision particularly optimizes the risk margin.
In terms of price, for mainstream critical illness insurance products, the price of critical illness insurance products will drop slightly under the premise of the same guarantee responsibility; for regular critical illness insurance products, the price of certain age groups will drop significantly.
Recently, the Insurance Industry Association of China and the Chinese Medical Doctor Association issued the "Specifications for the Use of the Definition of Critical Illness Insurance (2020 Revised Edition)", and the Chinese Association of Actuaries released the "Critical Disease Experience Table of China's Life Insurance Industry (2020)", China The China Banking and Insurance Regulatory Commission issued the "Notice on the Use of the "China Life Insurance Industry Experience Incidence Rate Table (2020)".
So far, the industry has been concerned about the revision of the critical illness insurance related regulations.
Statistics show that from 2007 to 2018 alone, Critical Illness Insurance provided consumers with more than 3,000 products, insured nearly 200 million people, paid about 1.8 million people, and paid more than 100 billion yuan.
At present, critical illness insurance accounts for nearly 60% of the total premiums of the health insurance business, and the revision of relevant regulatory documents has a profound impact on the development of the life insurance industry.
Introduction of the definition of mild disease for the first time
Jia Biao, deputy director of the Life Insurance Department of the China Banking and Insurance Regulatory Commission, said that critical illness insurance is an important type of insurance in my country's insurance industry, and whether the definition of disease is scientific and reasonable is the core of the responsibility of critical illness insurance products.
This revision of the critical illness insurance regulations introduces the definition of mild disease for the first time. The three core diseases, malignant tumor, acute myocardial infarction, and stroke sequelae, are classified into severe and mild diseases according to their severity.
The relevant person in charge of the Insurance Association of China stated that the scientific classification has fully adapted to the development of medical diagnosis and treatment technology on the one hand. Some diseases that were severely ill in the past, but the current diagnosis and treatment costs are low and the prognosis is good, are clearly defined as mild diseases, and the compensation standard is set. It is more scientific and reasonable; on the other hand, it also adapts to the actual development of the critical illness insurance market. It has formulated clear industry standards for the more common mild illnesses in the current market to regulate market behavior.
In terms of the number of diseases and the scope of coverage, the original 25 types of severe diseases have been fully defined and expanded into 28 types of severe diseases and 3 types of mild diseases, and the scope of coverage has been appropriately expanded.
Three new severe diseases were newly added, namely severe chronic respiratory failure, severe Crohn's disease, and severe ulcerative colitis.
At the same time, the scientific classification of the three core serious diseases of malignant tumors, acute myocardial infarction, and stroke sequelae has added the corresponding definitions of three mild diseases.
Previously, the industry was more concerned about whether thyroid cancer would be excluded from the scope of critical illness protection, and a final conclusion was reached after the release of the new regulations.
This revision does not exclude thyroid cancer, but classifies it according to the severity of the disease, and pays according to the severity.
According to the new standard, according to the severity of the disease, medical expenses and prognosis, the upper limit of the proportion of mild illness insurance is determined to be 30%.
The insurance company shall reasonably set the corresponding insurance amount for the new non-standard mild diseases added to the critical illness insurance products by the insurance company.
According to the latest medical progress, the new standard also expands the coverage of 8 diseases including major organ transplantation, coronary artery bypass graft, heart valve operation, and aortic operation, and optimizes the definition of 7 diseases including severe chronic renal failure.
In addition, regarding whether cancer in situ is included in the scope of critical illness protection, after comprehensive consideration, this revision will not include cancer in situ.
However, on the basis of the new regulations and the types of diseases, insurance companies can increase the responsibility for cancer in situ protection in critical illness insurance products to meet the diversified insurance protection needs of consumers.
Xing Wei, president of the Insurance Industry Association of China, said that after the implementation of the new regulations, insurance companies should further strengthen industry self-discipline, provide good customer service, and ensure stable and orderly business development.
At the same time, it will continue to strengthen cooperation with the National Health Commission and the Chinese Medical Doctor Association to explore the establishment and improvement of a long-term working mechanism for the definition and standardization of critical illness.
Revision of Critical Illness Table lays a solid foundation
If the revision of the definition of critical illness insurance has given consumers a new understanding of major diseases, then the revision of the new version of the critical illness list provides important information standards for insurance companies to design new products.
This revision of the Critical Illness Table realizes for the first time that the data information covers all life insurance companies, all critical illness insurance products, all business links of underwriting and underwriting claims, and all historical data covering the more than 20 years from the launch of self-gravity illness insurance products to the end of 2018. It sorted out about 2,900 disease insurance products, extracted 160 diseases, collected nearly 400 million underwriting data, and about 5.87 million claims data, and implemented manual supplementary records for about 750,000 claims organization industries with incomplete information.
In addition, the China Association of Actuaries has also fully used new technologies such as artificial intelligence, new methods such as machine learning models, and new tools such as automatic cleaning of claim texts during the revision process of the critical illness list, and completed the classification of more than 5 million claim texts. And 105 kinds of serious diseases, 55 kinds of mild diseases, 26 kinds of cancer sites, 80 kinds of death causes of the breakdown of claims, and formed a technology and application tools that can be directly exported to outside the industry.
It is worth mentioning that in this revision, for the first time, an exclusive reference table for the total experience incidence rate of diseases in the Guangdong-Hong Kong-Macao Greater Bay Area under the 2020 version of the definition was compiled, which plays an important role in the innovation and development of exclusive products in the Guangdong-Hong Kong-Macao Greater Bay Area.
For the first time, the reference table for the incidence of two representative diseases of the elderly under the 2020 version of the definition was compiled, which created a precedent for the research and analysis of the experience incidence of serious diseases in the elderly, which is of great significance to the innovation and supply of exclusive insurance products for the elderly.
Li Jinsong, deputy secretary-general of the China Association of Actuaries, said that the release of the revised results of the Critical Illness Table is important for the insurance industry to implement the important spirit of the Party Central Committee and the State Council, strengthen the infrastructure construction of the insurance industry, serve the financial supply-side structural reform, and prevent and resolve financial risks. The measures are also important measures to implement the strategic deployment of the Party Central Committee and the State Council on the construction of the Guangdong-Hong Kong-Macao Greater Bay Area, "Healthy China 2030", and advance the development of elderly care services, and promote the high-quality development of the insurance industry, adhere to long-term and stable operations, and protect consumer rights Such aspects are of great significance.
In the next step, under the guidance of the China Banking and Insurance Regulatory Commission, the China Association of Actuaries will further play its role as a professional platform, gather forces from the entire industry, explore the establishment of a long-term working mechanism for the dynamic adjustment of critical illness tables, and better serve the development of the health insurance industry.
New product pricing will have new changes
In the face of the revised new specifications and the new version of the critical illness list, consumers are most concerned about the changes that the critical illness insurance products will bring.
According to Jia Biao, the transition period for critical illness insurance products is from the date of publication to January 31, 2021. After the transition period, companies are not allowed to continue to sell critical illness insurance products developed based on the old standards.
This means that before the end of the transition period, products that have passed the record can continue to be sold, and new products will be sold if they pass the record. However, insurance companies may continue to upgrade or stop selling old products based on multiple factors such as rates and prices. product.
The reporter consulted a number of life insurance companies and learned that after the release of the relevant regulatory documents for soliciting opinions, various insurance companies have begun to calculate and adjust their critical illness insurance products.
With the release of the new regulations, new products will be successively submitted to the regulatory authorities for filing, and will be put on the market after approval.
In response, Jia Biao said that the China Banking and Insurance Regulatory Commission requires that insurance companies develop critical illness insurance products that meet the requirements of the new regulations.
Companies should also strengthen sales management, strictly prohibit misleading sales by switching between new and old specifications, and prohibit hype about stopping sales.
Regarding the issue of the price of new products that consumers are generally concerned about, the relevant person in charge of the China Association of Actuaries stated that there are many factors that affect the price of critical illness insurance products, including guarantee responsibility, interest rates, expense rates, and critical illness incidence rates. The sensitivity to various factors is different, and the incidence of serious illness is one of the important factors.
From the perspective of protecting the interests of consumers, this revision particularly optimizes the risk margin.
In terms of price, for mainstream critical illness insurance products, the price of critical illness insurance products will drop slightly under the premise of the same guarantee responsibility; for regular critical illness insurance products, the price of certain age groups will drop significantly.