Economic Observer reporter Wang QingAt the end of the year and the beginning of the year, insurance companies have entered the intensive release period of the 2023 claims annual report. As of January 10, 2024, a number of insurance companies, including Chinese Life, Ping An Life, Taiping Life, Fude Life Insurance, etc., have successively released annual claims reports.
Combing through the disclosed claims annual reports, the amount and number of claims of some insurance companies have increased compared with 2022, and the overall odds for consumers are above 98%.
Among them, Chinese Life had the largest number of claims and claims amount, with 22.13 million and 59.9 billion yuan, respectively, a year-on-year increase of 155% and 163%, and the consumer gets the odds of 997%, with an average daily payout of 16.4 billion yuan. In addition, Ping An Life claimed 4.98 million claims throughout the year, with a compensation amount of 44.2 billion yuan, and consumers received odds of 9920%；The number of claims of Fude Life Insurance was 3860,000 pieces, the compensation amount is 40100 million yuan, consumers get odds of 9819%。
According to the claims annual reports of various insurance companies, critical illness insurance is still the part with the highest claim amount. According to Ping An Life's 2023 claims annual report, the company's critical illness claims in 2023 will pay a total of 2490,000 pieces, with a compensation amount of 22.1 billion yuan, accounting for 50% of the total compensation amount.
Among the reasons for critical illness claims, malignant tumors accounted for 69%, ranking first in critical illness claims. Among them, the more common diseases in men include lung malignant tumors, thyroid malignant tumors and colorectal malignant tumors; Diseases that are more common in women include thyroid malignancies, breast malignancies, and lung malignancies.
With the gradual development of medical technology, the five-year survival rate of malignant tumors has steadily improved. According to the policy status statistics of Ping An Life customers, the five-year survival rate of Ping An Life customers for malignant tumors in 2023 is 64%, an increase of 6 percentage points from 58% in 2015.
It is worth mentioning that the current critical illness protection gap still needs to be paid attention to. According to the data on the cost of common critical illnesses released by the Chinese Association of Actuaries, the average medical expenses for critical illnesses are more than 100,000 yuan, but most insurance consumers do not have more than 300,000 yuan of critical illness protection, so it is not enough to fully cover the risk of critical illness. Take Taiping Life data as an example, 645% of the claims are less than $150,000.
The annual reports of insurance companies also show that the incidence of critical illness is at a younger age. According to the data of Ping An Life's claims annual report, from 2015 to 2023, the incidence of critical illness in the three age groups of 0-17, 18-30 and 31-40 is respectively %, which is higher than the incidence rate of the same age group in 2015, that is, more and more young people are at risk of critical illness. Chinese Life also reminded in its claims annual report that the detection rate of critical illnesses among people aged 25-45 underwritten by the company has increased from 6 per 10,000 in 20133, increased to 12 per 10,000 in 2022.
Claims settlement is a key part of the insurance industry's relief function. In order to solve the difficulties in insurance claims settlement and fully protect the rights and interests of financial consumers, the People's Mediation Committee of the Banking and Insurance Industry of Zhejiang Province set up the "Ant Mediation Studio" in July 2023 to explore a new model of insurance claims.
It is understood that when users have objections to the conclusion of the claim, they can apply for the "Peace of Mind Compensation" to help the mediation conclusion consulting service in Ant Insurance, and the compensation experts will give professional advice and assist in handling it. If the user still does not accept the conclusion of the agreement, the user can initiate a mediation request with one click and enter the Ant Mediation Studio. Professional people's mediators will organize mediation to communicate and resolve misunderstandings or conflicts between users and insurance companies, so as to protect the rights and interests of consumers to the greatest extent. During the half-year trial operation, the mediation resolution rate reached 97%.
Fang Yong, head of Ant Insurance's claims technology, said that the continuous improvement of the "safe claim" service system and user satisfaction of the Ant Insurance platform are the result of continuous construction with partner insurance companies in the past two years. In 2023, cooperative insurance companies will settle more than 23.1 billion yuan of claims from users on the Ant Insurance platform, a year-on-year increase of 23%. Taking health insurance as an example, in 2023, a total of 4.69 million health insurance claims will be served on the Ant Insurance platform, of which 4.59 million people will complete claims through "peace of mind claims", with a coverage rate of 98%.
At the same time, the continuous application of new technologies is also empowering insurance claims. As a result, keywords such as technology empowerment, digitalization, intelligence, and ** frequently appear in the claims reports of insurance companies.
Chinese Life is the first in the industry to launch medical electronic invoices, and apply them in the claim settlement process, realizing the transformation of electronic bills into data and the change of claims service from passive to active; Ping An Life has built an "intelligent claims" service system with "flash claims", "intelligent pre-claims", "direct and fast claims" and "AI intelligent claims" as the core.