Our reporter Su Xianggao

  Recently, isolation insurance, which was once a hit on online platforms such as Xiaohongshu and Zhihu, has received regulatory attention.

  The reporter of "Securities Daily" learned yesterday that the China Banking and Insurance Regulatory Commission has issued the "Urgent Notice on Regulating the Operation of the "Separation" Allowance Insurance Business to all the banking and insurance regulatory bureaus and property insurance companies on January 30, requiring insurance companies to start their business operations Self-inspection and rectification of isolation insurance-related businesses will be carried out in seven aspects such as concept and sales behavior, and the rectification situation will be reported before February 28.

  Why does the supervision urgently regulate the business related to isolation insurance?

The main reason is that the business has problems such as false publicity and difficulty in claim settlement.

In terms of false propaganda, the sales platforms previously claimed that "one day's isolation and earning thousand yuan" and "a cup of milk tea money can guarantee a year" are inconsistent with the actual situation; and in terms of claims settlement difficulties, Xu Yuchen, a founding member of the Chinese Association of Actuaries, said that There are five common types of refusal of isolation insurance.

  False publicity, difficulty in claim settlement

  The problem is prominent

  What kind of insurance does isolation insurance belong to?

What kind of protection is available to the policyholder?

Why did it become popular?

  In terms of product attributes, Xu Yuchen said that isolation insurance is actually an additional isolation responsibility for accident insurance.

Taking a previously best-selling product from an insurance company as an example, the insurance clause of this product is "Personal Accident Insurance (Internet Exclusive)". While assuming accident liability, it also expands coverage for insurance accidents caused by the new crown virus, including the new crown isolation allowance. .

  As for the reasons for its popularity, Wang Yin, general manager of Huize Life Insurance Commodity Center, told reporters that first, the product conforms to market changes and is repeatedly affected by the epidemic. While many insurance companies have developed related products, they have also expanded their coverage of insurance products caused by the new coronavirus. Second, this type of product has the characteristics of simple insurance, flexible insurance period, and friendly premiums.

  For example, the "Micro Travel - New Crown Isolation Allowance Insurance" launched by an insurance company costs only 27 yuan a year, but the coverage includes a daily centralized isolation allowance of 200 yuan for up to 30 days, a new crown critical illness benefit of 10,000 yuan, and a new crown death benefit. 100,000 yuan, 1 million yuan for plane/train/ship accident damage, and 100,000 yuan for auto accident damage.

  In addition, individual bloggers' experiences of "picking wool" published on some online platforms also contributed to the popularity of isolation insurance to a certain extent.

At the same time, many insurance companies have also vigorously promoted this type of insurance through WeChat public accounts, text messages and other methods to accelerate its popularity.

  However, behind the popularity of isolation insurance, many problems have also been exposed, among which false propaganda and claims difficulties are the most prominent.

For example, some sales platforms claim that "you can get compensation of 150 yuan to 1,000 yuan for one day of isolation", but the actual situation is that only certain and rare cases of isolation will receive corresponding compensation.

In addition, there have also been many cases of refusal of isolation insurance on complaint platforms such as Heimao.

  Five common situations

  Insurance company refuses to pay

  Why does the isolation insurance have the above problems?

In the eyes of industry insiders, insurance companies and consumers are inseparable from each other.

  For insurance companies, the advantages of isolation insurance premiums close to the people and wider coverage may mean high risks.

Due to the cheap premiums, from the perspective of risk control, insurance companies will inevitably set up many exemption clauses to control the amount of compensation, thereby reducing the risk of loss.

  In this regard, Xu Yuchen said that the limitation of insurance companies in terms of compensation has caused some consumers to have a bad experience in claim settlement.

According to statistics, there are five common types of refusal of compensation: first, close contact personnel are quarantined (for example, they do not take the same means of transportation as confirmed cases); second, non-self-funded isolation; third, home isolation, health monitoring; fourth, global control; Fifth, according to the requirements of the local government, the return of people from non-medium and high-risk areas, and the centralized isolation of people visiting relatives.

  From the perspective of consumers, some consumers do not read the exemption clauses carefully when purchasing isolation insurance, and the exemption clauses of some companies are placed in inconspicuous positions or the font is too small, which is difficult for consumers to find. There is no comprehensive understanding of coverage and claims coverage.

Therefore, it is easy to be rejected when the claim is settled, which leads to claims disputes.

  Regulatory punch

  Standardize isolation insurance

  With the frequent occurrence of difficult claims for isolation insurance, the supervision took action in a timely manner and issued emergency notices for problems such as false propaganda and difficulties in claim settlement, and regulated the business from seven aspects.

  In terms of business philosophy, in the process of developing and designing insurance products, insurance companies are required to be people-centered, based on the actual needs of insurance consumers, comprehensively consider insurable benefits and risk levels, and follow laws and regulations. Develop products and set reasonable conditions for exemption of liability and claims settlement.

  In terms of sales behavior, insurance companies are required not to make misleading publicity or explanations on important situations such as insurance product protection responsibilities by means of deception, concealment or inducement in the process of publicizing and selling the above-mentioned products. One-sided propaganda and malicious rendering and hype are carried out for the purpose of attracting attention.

  In terms of reminders and explanations, insurance companies are required to fully perform the obligation of explanation in the process of product sales, fully explain insurance liabilities, liability exemption and claims conditions, etc., and make provisions for exempting insurers from liability in accordance with laws and regulations that are sufficient to attract the attention of policyholders. Tips and Instructions.

  In terms of claims management, insurance companies are required to attach great importance to customer service, do a good job in explaining relevant business and follow-up insurance claims services, and take the initiative to provide claims services in the event of an insurance accident, and must not refuse claims without reason.

  In terms of complaint management, insurance companies are required to continue to pay attention to the follow-up operation of such businesses, strengthen the management of branches, marketing personnel and third-party cooperation agencies, strengthen business complaint management, pay attention to public opinion trends, and respond to consumers’ reasonable demands in a timely manner .

  In terms of market supervision, the China Banking and Insurance Regulatory Commission and its local offices should supervise and urge all companies to do a good job in the publicity and sales of such businesses, strengthen supervision and inspection, and conduct unreasonable product development and design, misleading sales, and unreasonable refusal of compensation according to laws and regulations. The legal responsibility of insurance companies and relevant responsible persons shall be investigated.

  In terms of self-inspection and rectification, companies operating such businesses are required to conduct self-inspection and rectification in accordance with the aforementioned requirements, and report the situation of self-inspection and rectification to the Property and Casualty Insurance Department of the China Banking and Insurance Regulatory Commission or the dispatched office under direct management before February 28, 2022.

  In general, the above-mentioned regulatory documents focus on key links such as exemption clauses and sales behaviors, which are likely to cause difficulty in claim settlement and misleading sales, directly address the crux of the problem, and comprehensively regulate all aspects of isolation insurance operations.

  isolation insurance

  Can you still buy it?

  Under the heavy blow of supervision, can insurance companies continue to sell isolation insurance?

Can consumers continue to buy isolation insurance amid occasional outbreaks across the country?

  Xu Yuchen said that for such products, insurance companies often adjust the test while developing the product.

The actuarial department and product development department of insurance companies will regularly review the data and decide whether to increase the price or stop selling according to the data.

For example, the isolation insurance launched by Fosun United Health has an initial premium of 43 yuan, then the price will increase to 59 yuan in October 2021, and the sale will be stopped in December 2021.

For insurance companies, if isolation insurance can be purchased by all, it is a profitable business.

However, the risk of adverse selection cannot be ignored. At present, people in low-risk areas of the epidemic are not very motivated to insure.

  Regarding the issue of claims settlement, Xu Yuchen said that first, the insurance company must clarify the insurance terms, and the insurable and non-insurable situations must be clear; secondly, the common problems must be listed one by one on the sales page.

In practice, due to the inconsistent risk classification standards in different places, insurance companies need to clearly inform consumers of the conditions for claim settlement according to specific situations; in terms of the claims settlement process, insurance companies should also list the required information in the form of examples according to the requirements of different cities. The proof material makes the product more professional and refined.

  From the perspective of consumers, Xu Yuchen said that isolation insurance is suitable for two groups of people: one is high-risk groups, such as doctors, cold chain workers, international flight service personnel, etc.; the other is people who have confirmed cases in their city or near the street .

Although the product has many deductible clauses, consumers can still be compensated as long as the agreed payment conditions for the purchased product are met.

(Securities Daily)