The insurance company doesn't pay for this, and it doesn't pay for that? 67 claims reports reveal the truth

　　Sino-Singapore Jingwei, January 28th (Wei Wei) Have you heard such a joke - the insurance company will not pay for two, this will not be compensated, and that will not be compensated.

With the disclosure of the annual insurance company claims report, your perception may be overturned.

　　The incomplete statistics of Sino-Singapore Jingwei found that the total financial settlement of 67 insurance companies in 2021 reached 232.360 billion yuan, and the total number of claims reached 387 million.

　　Among the above-mentioned insurance companies,

of the size of the company, the compensation rate is almost 97% or more, and even many insurance companies can reach 99%.

The claims report also revealed some more critical information. How to read the insurance company's claims report?

Sino-Singapore Jingwei will take you to take a look.

The odds are generally higher than 97%

　　Judging from the amount of claims disclosed by various insurance companies, the total amount of claims settled by 67 insurance companies reached 232.36 billion yuan.

Among them, the top 10 claims amount are China Life, Ping An Life, Pacific Life, PICC Life, PICC Health, New China Insurance, Zhong An Insurance, Taiping Life, Taikang Life, PICC Life, and Taikang Pension.

In terms of the total number of claims, ZhongAn Insurance is the best, with the number of prime claims reaching 329 million.

　　However, statistics from Sino-Singapore Jingwei found that the claims amount of the top 10 insurance companies alone reached 189.867 billion yuan, accounting for 81.71% of the total claims amount of the 67 insurance companies.

If the scope is expanded to the top 20 companies, it can be found that the compensation amount of these 20 companies reached 212.335 billion yuan, accounting for 91.38%.

　　In an interview with Sino-Singapore Jingwei, Zhu Minglai, director of the Health Economics and Medical Security Research Center of Nankai University and a professor of the Department of Insurance of the School of Finance, analyzed that the

　　When putting out an insurance policy, the insured is most concerned about whether the insurance will pay out in the event of an accident.

At this time, the insured can pay attention to the odds ratio announced by the insurance company, that is, the proportion of the number of people who receive compensation after the insured reports the case.

Among the 67 insurance companies, only 34 disclosed the odds, and from the data disclosed, all the odds reached more than 90%.

　　其中，中国人寿、新华保险、泰康养老保险等18家保险公司的获赔率达到99%及以上。34家披露数据的保险公司中，获赔率低于98%的共有四家保险公司，分别为瑞华人寿、国联人寿、中银三星人寿和人保人寿，该数据分别为94%、96.33%、97.01%和97.25%。

　　是不是大型保险公司比中小保险公司的理赔更爽快？在朱铭来看来，二者理赔体验相差并不大，“市场上的保险产品同质化比较严重，并没有太多差异化经营，各保险公司整体经营情况相差不大，中小险企也并不是理赔时矛盾会更多。”

　　他进一步介绍道，大型险企的服务网点更多，不仅在大城市铺设网点，在三四线城市甚至下沉至乡村也有，所以相对而言可能理赔服务更快，中小寿险公司的特点是基本集中于大城市，因此理赔速度也不会太慢。

仅4家公布出险支付时效

　　既然保险公司获赔率这么高，为何公众对保险公司还会有很难获得赔付的印象？其实这与理赔的办理程序和时效也息息相关。

　　中新经纬梳理发现，尽管有36家保险公司披露了理赔申请支付时效，但

还有保险公司公布了小额理赔支付时效，平均不到半天就能到账。

　　而大部分投保人更关心的是，前期从报案到收集材料的各种复杂过程、直至获得理赔金的全部时间。遗憾的是，在统计的67家保险公司中，仅中意人寿个险、农银人寿、国联人寿、前海人寿公布了出险支付时效，分别为44.34天、49.13天、49.2天、54.31天。

　　在朱铭来看来，保险理赔报案后所需的证明材料属于监管部门的要求，在前面需要一些流程也是正常现象。近年来，投保人和保险公司的矛盾主要体现在对条款的认知上，如免赔责任如何界定等等。

　　“过去大数据并不完善，有些得病记录难以查询，可能存在带病投保的情况，投保人隐瞒了自己的健康情况，并未对保险公司如实告知。保险公司在查询这些人的身体情况时，可能需要一些时间。目前在大数据下很容易发现这个人是否看过病，有何重大疾病病史，也相对减少了核查时间。”朱铭来说。

　　此外，中新经纬提醒投保人，要想提高理赔的效率，可提前询问保险公司需要的证明材料，注意收集与理赔相关的各种单据，出现险情时及时与保险公司取得联系。

重疾险保额不足

　　在理赔责任分布上，重疾险和医疗险占据了理赔金额的绝大部分。中新经纬统计的20家保险公司中，有11家保险公司两险种理赔金额占比超八成，重疾险占比超五成同样有11家。比如，平安人寿的重疾险和医疗险理赔金额合计占比达80%，太保寿险两者理赔金额合计占比81%，泰康人寿二者合计占比近83%。

　　自从“百万医疗险”问世以来，由于其价格较低、保额高，获得不少投保人青睐，医疗险得到了一定的普及。在日常生活中，出现一些意外和疾病的概率比重疾等要高出许多。从理赔件数看，医疗险出险最高的险种，不少保险公司的医疗险赔付件数占比超过90%。但从理赔金额来看，医疗险赔付件均金额较低，据光大永明人寿的年度理赔报告显示，

　　平时的小病小灾对于普通家庭而言尚能从容应对，而一旦出现重大疾病，对一个家庭而言可能将面临不小的经济压力，这时重疾险的作用便体现出来。从理赔报告中可以发现，虽然重疾险赔付件数占比较低，统计的20家险企占比均在20%以下，但理赔金额却占几乎半壁江山。

　　From the perspective of critical illness insurance claims, malignant tumors and cardiovascular and cerebrovascular diseases are still the two major "killers" that threaten health.

China Life pointed out that among the reasons for compensation, malignant tumors accounted for 75%.

Ping An Life also pointed out that

　　Many insurance companies also listed the main reasons for juvenile serious illness compensation, of which leukemia ranks first among the reasons for juvenile compensation.

In addition, thyroid malignant tumors, brain malignant tumors, lymphomas and germ cell tumors have also become the main diseases paid for.

　　So, what is the strength of the protection given by the critical illness insurance for these major diseases?

According to data released by China Life, 93.55% of the major illness claims amounted to 100,000 yuan or less, and only 3% of the 200,000 or more claims.

In terms of Taiping Life, the number of claims of 200,000 yuan and below accounted for 77.72%, and the number of critical illness insurance claims of more than 500,000 yuan accounted for only 3%.

The data of Great Wall Life also shows that 77.40% of the critical illness compensation amount is less than 100,000 yuan, and only 2.9% is 310,000 yuan and above.

　　The Taikang Life Insurance claims report pointed out that serious illnesses occur frequently, but people’s protection is not sufficient. The

Taikang Life reminds policyholders that commercial insurance, as a supplement to social security, is equipped with sufficient critical illness protection to effectively resist risks.

(Sino-Singapore Jingwei APP)