Commercial health risks break through the dilemma of getting sick insurance
As of the end of August, many insurance companies such as China Life, China Ping An, and Zhongan Online have successively announced their results for the first half of this year, and many insurance companies’ health insurance premiums have maintained a growth of more than 15%.
In recent years, the growth rate of commercial health insurance premiums has been able to stand out among the personal insurance products, which has a lot to do with the relaxation of the restrictions on "insurance with illness" by various insurance companies.
"Insurance with illness" was once a taboo in commercial health insurance. Once there is a pre-existing condition, not only can the insured not be able to purchase critical illness insurance, but other health insurance and life insurance will also shut out such people.
However, compared with the standard healthy population, the rejected population tends to have a stronger willingness and demand for insurance.
On the one hand, large non-standard groups such as sub-healthy people and chronically ill people cannot obtain insurance protection; on the other hand, the high homogeneity of products also makes the health insurance market fall into an unhealthy competitive environment.
Accelerating capacity expansion by taking insurance with sick bodies
From the initial "one-size-fits-all" refusal to non-standard people, to the "same treatment" of non-standard people and standard healthy people, the development of sick body insurance is not achieved overnight, but has experienced millions of medical insurance breakthroughs and benefits for the people. The exploration and practice of insurance entry.
In 2016, the million-dollar medical insurance with high insured amount, low premium and wide coverage became an Internet celebrity product as soon as it was launched.
Subsequently, the chronic disease body million medical treatment has relatively loose health requirements for the insured, making it possible for chronic disease groups such as breast nodules, thyroid nodules, and "three highs" to be insured.
In 2020, Huimin Insurance products will usher in an outbreak period.
In May 2021, the China Banking and Insurance Regulatory Commission issued the "Notice on Regulating the Urban Customized Commercial Medical Insurance Business of Insurance Companies" to guide the standardized development of the Huimin Insurance market, and local governments began to actively participate in Huimin Insurance projects.
The number of people participating in Huimin Insurance has increased rapidly from about 40 million in 2020 to about 140 million in 2021, and premium income has also exceeded the 10 billion yuan mark.
Huimin Insurance is not only affordable, but also further expands the coverage, including the elderly and those who have suffered from major diseases.
In addition, Huimin Insurance often does not require health notification in the insurance process, and the insurance conditions are very loose.
In the interview, the reporter learned that according to the degree of protection for people with major diseases, Huimin Insurance products can be classified into four categories: refusal to insure, insurable but not paying for pre-existing conditions, insurable and paying for pre-existing conditions but the level of compensation is lower than that of healthy people, and insurable. The policy also pays for pre-existing conditions and at the same level as a healthy body.
With the gradual deepening of government participation, Huimin Insurance's mainstream protection model for patients with pre-existing conditions has advanced from "insurable but not indemnable" to "insurable and indemnable".
The reason why Million Medical Insurance and Huimin Insurance can achieve low premiums and high protection is that enough healthy people can share the medical costs of sick people and pre-existing patients when the insurance participation rate is high enough.
Compared with the million-dollar medical insurance, Huimin Insurance has more relaxed requirements for health notification and pre-existing conditions when applying for insurance, and there are no restrictions on pre-existing medical insurance in many places, but there is an upper limit on the amount of compensation.
In addition, special disease insurance also provides non-standard groups with more options beyond basic medical insurance.
At the end of April this year, China Life Reinsurance Co., Ltd. and PICC Health launched "Xin e Insurance Medical Insurance" (pulmonary nodule version) to provide "disease course management + insurance protection" for people with pulmonary nodules.
Zhang Chu, deputy general manager of the Actuarial Pricing/Product Development Department of China Re Life Insurance Company, said that in the future, the two parties will also make effective use of the product innovation laboratory platform, continue to expand cooperation areas, attach importance to risk management and control, and launch more and better products for online sales.
Internet insurance increases the reach rate
In recent years, Internet insurance products have become an important channel for the insurance industry due to the characteristics of multiple options, convenient and fast insurance application, and low promotion costs.
In late July, China Property & Casualty Insurance, Yongan Insurance, and Shuidi Insurance Brokers Co., Ltd. launched the Shuidi Blue Ocean series of critical illness insurance, which is a one-year critical illness insurance that exempts health notices during the insurance process.
Health notification means that the insurance company asks the insured person's health status through a questionnaire when accepting the customer's application for insurance.
Under normal circumstances, insurance companies need to measure underwriting risks and prevent fraudulent insurance through health notifications, and make different underwriting decisions for different customers, such as directly rejecting insurance for people with diseases or ineligibility.
Teng Hui, chief actuary of Shuidi Company, believes that the underwriting risk of people with sick people is indeed relatively high, but this is a population with a large base. It is possible to diversify and reduce risks by expanding the underwriting population, and at the same time, strengthen scientific claims verification at the claims end, and reduce risks. controlled within an acceptable range.
A number of industry insiders told the Economic Daily reporter that although the exemption of health notification can simplify the insurance process and facilitate online users and non-standard groups to apply for insurance, it may also cause potential disputes in the claims process.
In essence, critical illness insurance products exempt from health notification are no different from other critical illness insurance available for pre-existing conditions. They still only cover new diseases and do not cover all pre-existing conditions and their complications. Newly contracted diseases that meet the terms of the insurance policy.
Some people in the industry believe that this is another form of health notification in actual effect, which transfers the insurance company's original underwriting work in the insurance process to the claims process.
Some people in the industry also believe that this kind of attempt is in line with the model of Internet insurance products, which is "wide entry and strict exit", and whether it can withstand the test of the market in the end, we need to continue to wait and see.
With the development of Internet insurance, a new type of underwriting method has emerged—smart underwriting. Consumers only need to operate online, and the system will automatically judge the underwriting results.
Compared with manual underwriting, intelligent underwriting saves time and effort, can improve the efficiency of the insurance application process, and facilitate non-standard groups to apply for insurance.
From the perspective of risk control, manual review is relatively able to deal with complex situations, while smart underwriting is convenient but has a certain rate of misjudgment, which is easy to bury hidden dangers for claims disputes.
In October 2021, the China Banking and Insurance Regulatory Commission issued the "Notice on Further Regulating Matters Concerning the Internet Personal Insurance Business of Insurance Institutions", which regulates intelligent underwriting, proposes that automatic underwriting should be fully realized as soon as possible, and encourages insurance companies to apply scientific and technological means to improve underwriting. quality, improve underwriting efficiency, further improve anti-fraud capabilities and levels, and explore differentiated and intelligent underwriting; underwriting management should be strengthened, full underwriting information should be mastered, underwriting standards should not be lowered, and underwriting responsibilities should not be reduced.
In April this year, Huize Insurance Network launched a digital underwriting system. On the basis of obtaining user authorization, "senior underwriting experts + automated analysis system" accurately determine the user's risk label, and conduct targeted analysis and interpretation. Then, according to the needs of users, it is matched to insurance companies and insurance products with different risk preferences.
The person in charge of the Huizai digital intelligence system said that for non-standard populations such as chronic diseases, on the one hand, the digital intelligence system can analyze the disease status more objectively, and combine with product underwriting trends to give users more accurate health management and management. Underwritten medical advice.
On the other hand, the digital underwriting system can more widely access the underwriting information of products on sale, and then accurately recommend products with better underwriting conclusions to users, assisting users to complete insurance protection configuration.
Internet insurance products are not only exploring to simplify the insurance process, but also making progress in the intelligentization of the claims process, allowing users to complete claims in a shorter time.
Taking Zhongan Health Insurance as an example, the 2022 health insurance claims service semi-annual report released by Zhongan Insurance shows that 95% of claims are filed online, the completeness rate of one-time submission materials reaches 94%, and the pass rate of intelligent claims reaches 30%.
Integrated health management services
In recent years, health insurance and health management have shown a trend of integration.
With the improvement of public health awareness, people's health needs are not limited to health insurance, but also pay more attention to the improvement of their own health status.
At the same time, the protection objects of commercial health insurance have expanded from healthy people to non-standard groups such as sub-health, chronic diseases, and the elderly, and these groups need health management services more than healthy people.
By providing targeted indicator monitoring, lifestyle guidance, chronic disease intervention and other health management programs, health insurance can help non-standard groups to obtain inclusive and practical health services, reduce the incidence of diseases, improve the health of the insured people, and improve the health of the insured. Reduced health insurance claims.
The degree of integration of health insurance and health management still needs to be further deepened.
The medical management services attached to traditional health insurance usually have the characteristics of low perception, low frequency of use, and not being trusted by the public. They lack close cooperation with hospitals, pharmaceutical companies, rehabilitation institutions and social security systems, making it difficult for patients to seek medical treatment. The assessment has affected the industry's own supply and the improvement of its risk control capabilities.
If the practicability of services cannot be improved, health services will only become a gimmick for packaged products and directly affect insurance consumers' satisfaction with the products.
Zhang Lixing, director of the Shenzhen Banking and Insurance Regulatory Bureau, said at the 2022 Health Insurance and Health Management Integration Development Summit that health management services are currently only an additional service for insurance institutions and often need to be purchased from third-party institutions.
Shenzhen Bureau of Banking and Insurance Regulatory Commission encourages insurance institutions to adjust their development strategies and optimize their business structure, and conduct whole-process management by establishing strategic cooperation with health management institutions, jointly developing products, and investing in the industrial chain to create a new "insurance + health management". model.
Internet insurance products focus on the deep health needs of non-standard groups such as chronic diseases, and provide integrated security services in the field of chronic disease management.
The "14th Five-Year Plan for National Health" issued by the General Office of the State Council proposes to continue to promote the transformation of the development mode from focusing on medical treatment to focusing on people's health, provide the masses with a full range of full-cycle health services, and promote the slow development of the Internet. applications in disease management and medical services.
For example, ZhongAn Health Insurance launched a series of chronic disease insurances, which designed integrated medical insurance of "medicine + medicine + insurance" for people with chronic diseases such as liver disease, epilepsy, and diabetes. A series of disease management services such as online consultation, prescribing medication, popular science patient education, and sugar control management can meet the treatment and rehabilitation needs of chronic disease patients throughout the course of the disease.
The 2022 health insurance claims service semi-annual report released by Zhong An Insurance shows that in the first half of 2022, Zhong An Insurance has provided online consultation services for 210,000 people, arranged more than 2,600 critical illness green passes, and paid 390 million yuan in advance for medical expenses. , providing customers with more than 5,700 direct payment services for special drugs.
Facing the new format of "Internet + outpatient clinic", China Re Life Insurance also started from the needs of patients for consultation and purchase of medicines under the epidemic, and conducted research on consumer medical products for outpatient and emergency medicine purchases on the Internet.
By looking for service providers with excellent qualifications and high service quality, we can jointly develop products with lower insurance thresholds, simple underwriting, affordable prices, and clear protection responsibilities, which can not only meet the needs of new citizens for "online consultation, logistics and drug delivery" The actual needs have enriched the choice of commercial health insurance mainly purchased by individuals.
At the beginning of this year, the China Banking and Insurance Regulatory Commission issued the "Report on Issues and Suggestions on the Development of Commercial Health Insurance in my country" to various personal insurance companies. Included in the scope of protection, while reducing the incidence of diseases and improving the health level of the insured people.
In the long run, this may be the next direction for the health insurance field.
Yu Yong Yang Ran