The China Banking Regulatory Commission issued a document to regulate health insurance business——

Short-term health insurance cannot guarantee renewal

  Our reporter Yu Yong and Li Chenyang

  In recent years, the health insurance business has developed rapidly, with an average annual growth rate of more than 30%, and has attracted widespread attention from all walks of life.

While short-term health insurance is developing rapidly, it also faces some outstanding problems.

First, some products lack a pricing basis, and the insurance coverage is inflated; second, some companies have irregular sales behaviors, selling short-term health insurance as long-term health insurance, and once the loss ratio exceeds expectations, they will stop selling the products, seriously infringing on the interests of consumers ; Third, the underwriting claims are not standardized; fourth, disorderly competition, which is not conducive to the formation of a correct health insurance consumption concept for the whole society.

Recently, the China Banking and Insurance Regulatory Commission issued the "Notice on Regulating Issues Related to Short-term Health Insurance Business" (the "Notice") to regulate short-term health insurance such as falsely high insurance coverage, irregular sales underwriting, and disorderly competition.

  The short-term health insurance regulated by the "Notice" refers to the health insurance that insurance companies sell to individuals for a period of one year or less and does not contain a guaranteed renewal clause.

Except for group insurance business.

The relevant person in charge of the China Banking and Insurance Regulatory Commission stated that the "Notice" is problem-oriented, focusing on outstanding problems in the development of the industry's short-term health insurance business, adopting targeted regulatory measures, complementing the shortcomings of the regulatory system, and clearly communicating short-term health insurance to the industry The signal of standardized business operation provides institutional guarantee for the sustainable development of the industry's health insurance business.

  "Guaranteed Renewal" side ball cannot be played

  The reporter learned during the interview that many popular short-term medical insurance on the Internet use slogans such as "renewable to 80 years old" and "renewable to lifetime".

The "Notice" stated that it is strictly forbidden for insurance companies to mislead consumers by "short-term insurance and long-term insurance" through alienated product design.

It is clear that short-term health insurance shall not guarantee renewal, and shall not use words such as "automatic renewal", "commitment to renewal" and "lifetime limit" that are easily confused with long-term health insurance.

  Internet insurance expert and insurance broker Zhang Dashuai said in an interview with a reporter from Economic Daily that the insurance period of short-term health insurance products is generally one year or less, and there is no guarantee for renewal.

Health insurance that has an insurance period of more than 1 year or includes a guaranteed renewal liability is a long-term health insurance.

At the same time, for cost-compensated health insurance products, their responsibilities follow the principle of loss compensation. Medical expenses incurred cannot be claimed repeatedly, and consumers are not recommended to buy similar products repeatedly.

  Wei Chenyang, director of the China Insurance and Pension Research Center of the National Institute of Finance, Tsinghua University, believes that the "Notice" is very problem-oriented and problem-solving, and it regulates the irregular behavior of short-term health insurance in sales and claims.

For example, it is not allowed to play a side-ball on "guaranteed renewal", which is distinguished from long-term medical insurance.

Although commercial medical insurance provides guaranteed renewal to protect the interests of customers, it is the direction guided by government regulatory agencies in various countries, but at present, my country's property and casualty insurance companies can only operate short-term health insurance for one year or less. It is simply a good product. Selling and pushing "guaranteed renewal" is not conducive to the healthy development of the market.

The "Health Insurance Management Measures" revised in 2019 gives insurance companies the right to adjust premium rates and encourage the development of long-term medical insurance.

This shows that in terms of product and market development, policy regulators have taken into account the trend of long-term medical insurance, but it certainly cannot exist in the form of short-term insurance guarantee renewal.

  Sword refers to the settlement of claims, low rates, high stubborn diseases

  In December last year, Huang Hong, vice chairman of the China Banking and Insurance Regulatory Commission, stated at the State Council’s regular policy briefing that although short-term health insurance has a high amount of coverage, the amount that can actually be paid is relatively small, and there is disorderly competition and price wars. The problem.

In this regard, the "Notice" clearly requires that insurance companies' product pricing should have a pricing basis, and should not set an inflated insurance amount that seriously deviates from the data basis of claims settlement experience.

At the same time, insurance institutions are required to regularly disclose the overall comprehensive loss rate of short-term health insurance business on the company's official website, and accept supervision from all walks of life and insurance consumers.

Zhu Junsheng, a researcher at the China Insurance and Pension Research Center of the National Institute of Finance, Tsinghua University, believes that the current industry’s short-term health insurance has a tendency to "auto insurance", that is, the loss rate is not high, the expense rate is high, and the consumer protection costs account for Low, which is contrary to the comprehensive cost structure of high loss ratio and low expense ratio in international experience.

  In addition, the "Notice" prohibits the "hollowing" of underwriting by insurance companies and the "underwriting" of claims, infringing on the interests of insurance consumers.

Insurance companies are required to set health notification information in a standardized manner, and the setting of health notification information must not violate general medical common sense.

Many industry insiders told reporters that these regulatory requirements are very targeted.

Previously, some health insurance products were too loose in insurance and too strict in claim settlement.

This will lead to an increase in the rejection rate of some short-term health insurance products and an increase in complaints, which will affect the overall development of the industry.

  Product rights and obligations need to be reminded

  In terms of product portfolio sales and suspension, the "Notice" emphasizes that it is strictly forbidden for insurance companies to alienate product portfolio sales into bundled forced tying, restrict consumers' right to purchase products and services, and infringe on the interests of insurance consumers.

Insurance companies are strictly prohibited from arbitrarily stopping the sale of insurance products to make up for their losses caused by radical operations and infringe on the interests of insurance consumers.

Insurance companies are required to publicly disclose specific product suspension reasons, suspension time, and follow-up service measures through the company's official website and instant messaging.

  It is worth noting that the "Notice" proposes the establishment of a short-term health insurance insurance reminder system, requiring insurance companies to provide insurance applicants with insurance instructions when selling short-term health insurance products, and highlight important product rights and obligations that insurance consumers should pay attention to. , To prevent sales staff from misleading behavior, causing damage to consumers' own interests.

At the same time, it clearly stipulates the minimum cash value calculation standard, and short-term health insurance products that have been approved or filed by insurance companies before the issuance of the "Notice" and do not meet the requirements of this "Notice" shall stop selling before May 1, 2021.

  The relevant person in charge of the China Banking and Insurance Regulatory Commission stated that the issuance of the "Notice" will help guide the standardized development of short-term health insurance businesses, protect the legitimate rights and interests of consumers, and help maintain fair and reasonable competition in the market.

In the next step, the China Banking and Insurance Regulatory Commission will continue to improve the regulatory rules system, consolidate the main responsibility of insurance company management, supervise insurance institutions to regulate business operations, improve management levels, effectively protect the legitimate rights and interests of insurance consumers, and better meet the health protection of the people demand.

Wei Chenyang believes that the future will present a pattern of win-win development of short-term health insurance and long-term health insurance.

Short-term health insurance has the characteristics of flexible product design, high leverage, and no renewal pressure, while long-term health insurance has the characteristics of providing long-term protection with adjustable rates and better integration with health management, which can adapt to different consumers. Diversified needs.