Reporter of Meike: Tu Yinghao Yuan Yuan Editor of Meike: Liao Dan
Under the situation of industry premium decline, the health insurance business achieved original premium income of 844.7 billion yuan in 2021, a year-on-year increase of only 3%. Compared with the compound growth rate of 27% from 2015 to 2020, the growth rate of health insurance has slowed down significantly. Judging from the product structure of health insurance, the customer needs of critical illness insurance , the top insurance type, was released early last year. With the implementation of the new regulations on short-term health insurance and the development of the people's welfare insurance business, millions of medical insurance have been continuously impacted.
Recently, with the 2021 short-term health insurance compensation rate data, the claims settlement situation of various insurance companies has surfaced. Up to now, 125 insurance companies have disclosed relevant data. According to statistics from reporters of " Daily Economic News ", the overall compensation rate of the industry is relatively low. More than 70% of insurance companies' short-term health insurance business has no more than 50%, and more than half of insurance companies' overall compensation rate is less than 40%. Compared with the 2020 data, the indicators of companies in the industry have significantly differentiated, with half of each rising or falling.
Regarding the reasons for the low short-term health insurance claims rate, an industry insider pointed out to reporters that on the one hand, the million-dollar medical insurance users are concentrated in the age group of 30-45 years old, and the low claims rate for this group, resulting in a low overall claims rate. On the other hand, most of the million-dollar medical product plans on the market are reimbursed for the remaining reasonable medical expenses after deducting a certain deductible. According to National Bureau of Statistics data, the total per capita health expenses in 2020 were 5146.4 yuan, an increase of about 10% over the previous year, far lower than the general deductible amount of 10,000 yuan or 20,000 yuan in the market.
Data obtained by reporters from the industry by "Daily Economic News" shows that short-term health insurance such as million-dollar medical insurance is currently seriously homogeneous, customer recognition is not high, and sales are gradually declining. At present, the renewal rate of short-term health insurance in the industry remains at around 50%. "The traditional million-dollar medical insurance is coming to an end." Many insurance industry insiders said in an interview that in this case, in addition to further expanding the scope of protection, various insurance companies have also begun to expand the insurable population, differentiated pricing of sub-price and senior-age groups to further seize market share.
125 insurance companies disclose short-term health insurance business data
More than 70% of insurance companies' claims rate is less than 50%
According to the "Notice of the General Office of the China Banking and Insurance Regulatory Commission on Issues Related to Standardize Short-term Health Insurance Business", insurance companies should disclose the overall comprehensive compensation rate indicator of personal short-term health insurance business on the company's official website every six months. Among them, the compensation rate indicator for the first half of the year should be disclosed no later than the end of July each year; the annual compensation rate indicator should be disclosed no later than the end of February of the following year.
Insurance company's comprehensive compensation rate data for short-term health insurance in 2021 is released. The statistics from the reporter of "Daily Economic News" show that among the 125 insurance companies that have disclosed relevant data, more than 70% of the insurance companies' short-term health insurance business have an overall compensation rate of no more than 50%, and more than half of the insurance companies' overall compensation rate is less than 40%. Specifically, the claims rates of various insurance companies have risen and fallen. Compared with the 2020 data, the comprehensive claims rates of short-term health insurance in 69 insurance companies have increased, while the comprehensive claims rates of short-term health insurance in 50 insurance companies have decreased. In addition, there are 6 insurance companies that do not have last year's data and cannot obtain comparative data.
"From the perspective of the mature international market, it is a reasonable state to have a stable-developed health insurance business compensation rate of 70%-80%. "An insurance industry insider told the reporter of "Daily Economic News" that if the compensation rate of domestic health insurance business reaches 70% or 80%, considering the high cost rate, it is likely that the comprehensive cost rate will exceed 100%. Compared with the 2020 data, the comprehensive compensation rate of short-term health insurance for most insurance companies did not change much last year, and only a few companies have a large fluctuation in data, but the reasons are different for each company.
Take Guohua Life as an example. In 2020, the comprehensive compensation rate of Guohua Life's short-term health insurance was 173.87%, while by 2021, the comprehensive compensation rate of Guohua Life's short-term health insurance turned from positive to negative, at -13.29%. Regarding the changes in the data, Guohua Life Insurance stated that in the above-mentioned compensation rate, the premiums of the insurance have been earned by according to the estimated cost of claim . Since the pending compensation reserve after reinsurance is negative, and its absolute value is greater than the compensation expense after reinsurance, the comprehensive compensation rate is negative.
There are also companies' compensation rate data that has increased significantly. In 2020, the comprehensive compensation rate of Hengqin Life short-term health insurance was 12.75%, but by 2021, the comprehensive compensation rate of short-term health insurance rose sharply to 97.01%. In this regard, Hengqin Life Insurance told the reporter of "Daily Economic News" that the increase in the compensation rate is due to the different disclosure calibers. The comprehensive short-term health insurance compensation rate in 2021 has increased the compensation data of the group health insurance business.
It should be pointed out that according to the requirements of the " Health Insurance Management Measures ", short-term health insurance refers to health insurance whose insurance period is one year or less, and does not contain guarantee renewal terms , and is only for personal business. In other words, the short-term health insurance claims disclosed by insurance companies are limited to personal business only, and business based on group medical care is not included. According to Hengqin Life Insurance, while the company implemented the implementation in accordance with regulatory requirements, it joined the compensation rate data of the group's short-term health insurance business in order to give customers a more comprehensive understanding of the company's insurance compensation situation.
45 insurance companies’ compensation rate is between 30%-50%
Last year, 6 companies “reimbursed”
"Daily Economic News" reporter noticed that the short-term health insurance compensation rate data of 45 insurance companies in 2021 fell within the 30%-50%.
It is worth mentioning that judging from the data of several leading companies, the downward trend has been particularly obvious in the past year. For example, the overall comprehensive compensation rate of PICC Property Insurance in 2021 was 52.9%, lower than 53.89% in the first half of 2021 and 59.98% in 2020. In addition, the comprehensive compensation rate data disclosed by Ping An Life in 2021 was 38.2%, down 8.1 percentage points from 46.3% in 2020. ZhongAn Online disclosed a comprehensive compensation rate data in 2021 was 34.1%, down 2.2 percentage points from 36.3% in 2020.
ZhongAn Online's 2021 claim report pointed out that under the promotion of medical insurance inclusiveness, in order to reduce the medical expenses of cancer patients, a total of more than 50 types of cancer special drugs have been included in medical insurance, and the price of cancer special drugs has dropped by more than 50% after entering medical insurance. According to the report data, Zhongan Health Insurance has paid nearly 100% of the reasonable medical expenses for serious illnesses that patients bear. The number of cancer customers benefited from special pharmacy claims has increased exponentially. The average cost of special medicines required by lung cancer patients decreased by 70%, and the average cost of special medicines required by breast cancer patients decreased by 73%.
In addition, the compensation rate data of only 16 insurance companies exceeds 60%. Among them, six insurance companies lost short-term health insurance last year. The comprehensive short-term health insurance claims rate data in 2021 showed that Hetai Life Insurance, Hengda Life Insurance, Shanghai Life Insurance, Kaiben Property Insurance, Anxin Agricultural Insurance, and Haixia Jinqiao Property Insurance were 3442%, 394.64%, 205.02%, 168.17%, 120.28% and 112.02% respectively.
Hetai Life Insurance's comprehensive short-term health insurance compensation rate reached 3442% last year. "Daily Economic News" reporter noticed that Hetai Life Insurance disclosed that there are only two short-term health insurances for sale in Hetai Life Insurance in 2021, namely: Hetai Ankang Critical Disease Insurance and Hetai Suixin Insurance Critical Disease Insurance . According to the data, the comprehensive compensation rate of Hetai Ankang Critical Illness Insurance reached 6060%, while the comprehensive compensation rate of Hetai Suixinbao Critical Illness Insurance was -106%.
Hetai Life Insurance stated that the reason for the high comprehensive compensation rate of Hetai Ankang Critical Disease Insurance is that the product scale is small, and the compensation rate is greatly affected by a single claim case and fluctuates greatly. The reason why Hetai Suixinbao Critical Illness Insurance’s comprehensive compensation ratio is negative is the release of pending compensation reserves.
Shanghai Life Insurance, whose 2020 compensation rate data is over 100, hit a new high in the short-term health insurance compensation rate in 2021, at 205.02%. Regarding the high short-term health insurance claims rate, Shanghai Life Insurance told the reporter of "Daily Economic News" that this may be related to the iteration and upgrading of some of the company's products. Since the related products account for a small proportion of the company's business scale, it has a small impact on the company's operations overall. In the future, the company will also pay close attention to the changes in this data. If it continues to be high, it is not ruled out that the possibility of adjusting and optimizing related products will not be ruled out.
Shanghai Life Insurance Announcement shows that as of December 31, 2021, the top three products with the compensation rate have been suspended. Other personal short-term health insurance businesses on sale have been short and the compensation rate data are currently fluctuating greatly. Shanghai Life Insurance will continue to monitor the compensation rate of related products and take corresponding adjustment measures.
"Some insurance companies have a short-term health insurance business for a short time and have a small business volume. Their compensation rate is greatly affected by accidental factors. It is not representative, may be higher or lower." An insider of an insurance company told the reporter of "Daily Economic News" that the compensation rate is not of much reference significance for individuals to purchase insurance, because the reasons affecting the compensation rate are different, and consumers do not know whether they will pay or when compensation will occur.
000 Securities research report view believes that for insurance companies, increasing the disclosure of compensation rates will promptly encourage them to strengthen real-time monitoring of their operating conditions. If expectations deviate significantly from actual data, insurance companies can respond in a timely manner and adjust actuarial assumptions based on actual experience. At the same time, the transparency of claims data is conducive to the regulatory authorities' monitoring of the entire market, promptly discovering and solving problems, and maintaining the long-term and stable development of the market.
The overall compensation rate is low
"high insurance + high deductible" concept failed
Since the industry launched its first million-dollar medical insurance product in 2016, million-dollar medical insurance has gradually become the "rise" of health insurance, and more and more industry participants are constantly pouring into this track. Against the backdrop of the outbreak of the new crown epidemic in 2020, the scale of short-term health insurance represented by millions of medical insurance has grown rapidly. According to the relevant data of iResearch Consulting , the scale of China's million-dollar medical insurance premium income in 2019 was 34.5 billion yuan, a year-on-year increase of 102.9%, and the number of service users reached 90 million in 2020.
With the continuous growth of the market share of million-dollar medical insurance, the question of whether such "high insurance amount and low insurance premium" mid-range medical insurance can get claims and how many claims can be obtained has also become one of the most concerned issues for consumers. China Life 2021 claims annual report shows that the premium of a million-dollar medical insurance product is 2.5 times the premium of ordinary medical products, and the compensation amount is 10 times that of ordinary medical insurance products. The same customer has a maximum compensation of 68 times. The cumulative maximum compensation amount of the same customer exceeds 2 million yuan, effectively alleviating the pressure on customers to seek medical treatment.
Regarding the current situation where the short-term health insurance claims rate data was relatively low last year, Tang Jingdong, director of Huize Property Insurance Profit Center, analyzed that on the one hand, the million-dollar medical insurance user group is concentrated in the age group of 30-40 years old, and the low claims rate of this group, resulting in a low overall claims rate. On the other hand, most of the million-dollar medical product plans on the market currently reimburse the remaining reasonable medical expenses after deducting a certain deductible (10,000 yuan or 20,000 yuan). According to data from the National Bureau of Statistics, the total per capita health expenses in 2020 were 5,146.4 yuan, an increase of about 10% over the previous year, far lower than the deductible.
In addition to the problem of low compensation under high deductibles, Million Medical Insurance also faces the debate about the inflated coverage. The so-called "million-million medical insurance" covers basically one million yuan, and some even reach hundreds of millions of yuan, but in fact, there are only a few claims that are reimbursed to more than one million yuan. . Huang Hong, vice chairman of the China Banking and Insurance Regulatory Commission, also publicly pointed out at the regular policy briefing of the State Council that short-term health insurance has the problem of "high coverage, but low claims expenditure".
At the beginning of 2021, the China Banking and Insurance Regulatory Commission issued the "Notice on Issues Related to Standardize Short-term Health Insurance Business", requiring insurance companies to reasonably determine the short-term health insurance product rates, deductibles, compensation ratios and insurance amounts based on factors such as the actual level of medical expenses, claims experience data, etc. Insurance companies shall not set inflated insurance amounts that are seriously deviate from the basis of claims experience data.
"Daily Economic News" reporter noticed that some ultra-high insurance coverage of millions of medical insurance is gradually disappearing from the market. Taking a hot-selling million-dollar medical insurance, which claims to be insured by 6 million, as an example, some consumers reported that "the insurance amount was reduced to 4 million yuan when renewing the insurance." Regarding the reduction of the insured amount by 2 million, industry insiders believed in the interview that this itself has little impact on product pricing.
"Million Medical Insurance is a expense reimbursement insurance. Some of the medical expenses of customers' large compensation for medical expenses have been reimbursed through the social basic medical insurance system or unit.Million Medical Insurance only reimburse the difference in reimbursement in accordance with the insurance's 'compensation principle'.In addition to the restrictions on high deductibles, high compensation cases occur less. Even if there are imported drugs outside the hospital, few people will make claims of more than 1 million yuan. "The above-mentioned person analyzed that
Huimin Insurance is coming, and the new regulations are implemented
short-term health insurance living environment has changed
In the past two years, another "strong general" has been added to the health insurance market. Huimin Insurance has been rapidly spread across the country, which has had an impact on million-dollar medical insurance. China Renewal Life Insurance previously released a report that after the large-scale launch of Huimin Insurance products, the concept of "high insurance + high deductible" implemented by Million Medical has been further impacted. At the same time, Huimin Insurance has formed a crushing trend in terms of premiums and accessibility of sick bodies. China Renewal Life Insurance also stated in the report that before that, Million Medical Insurance had actually faced the problem of saturation of the coverage.
from the product At the operating level, a lower comprehensive cost rate level means that insurance companies have greater profit margins. iResearch Consulting believes that after taking into account the company's operating R&D and other expenses, the profit possibility of this type is considered with the comprehensive cost rate. Compared with credit insurance, accident insurance, auto insurance and liability insurance, the comprehensive cost rate of Million Medical Insurance is lower, and there is still a lot of room for adjustment in the profit level.
Tang Jingdong believes that it has been 6 years since the market appeared in the market, and the compensation rate is relatively stable. In the short term, there will be no small and medium-sized companies withdrawing from the market due to worsening compensation situations, but they may withdraw from the market because their products are not competitive and the market is squeezed by the cost-effective products of Huimin Insurance and the leading insurance company. .
With the issuance of the Notice of the General Office of the China Banking and Insurance Regulatory Commission on Further Standardizing Internet Personal Insurance Business of Insurance Institutions in October last year, a large number of short-term health insurances that do not meet regulatory requirements were removed from the shelves in batches. The reporter of "Daily Economic News" noticed that in terms of product quantity, the short-term health insurance products of some insurance companies have significantly decreased, and many small and medium-sized companies have suspended Internet insurance business because they do not meet the operating threshold requirements.
However, with the arrival of the wave of shutdowns of leading network mutual aid, the industry predicts that this will further release space for the health insurance sinking market. Ping An Securities stated in the research report that according to According to the analysis of the customer base of Mutualbao and , members aged 40 and under account for 60%. The price of such users to purchase "Million Medical" is about 500 yuan. The brokerage expects that it will bring an increase of at least 4.5 billion yuan to short-term commercial health insurance.
AXA Insurance (Bermuda) Co., Ltd. Life Insurance and Health Insurance Reinsurance China Business and Customer Head Li Chunkan told the reporter of "Daily Economic News" in an interview: "This year the overall regulatory environment for health insurance is strict, and the challenges for small and medium-sized companies to operate medical insurance have increased. In the short term, Million Medical is still the main force of Chinese health insurance medical products, and small and medium-sized insurance companies will still tap into the potential market opportunities of Million Medical. "
renewal rate is only 50%
insurance companies seek differentiated competition to break through
million medical insurance, and low renewal rate is also a big challenge. Data obtained by the "Daily Economic News" shows that the current short-term health insurance renewal rate in the industry remains at around 50%.
"Notice of the General Office of the China Banking and Insurance Regulatory Commission on Issues Related to Standardize Short-term Health Insurance Business" requires that the short-term health insurance products developed by insurance companies include renewal liability, which should be clearly stated in the insurance terms as the "no guaranteed renewal" clause, and insurance companies shall not short-term The term health insurance product terms and promotional materials use words and sentences that are easily confused with long-term health insurance. Based on the provisions of the China Banking and Insurance Regulatory Commission, Tang Jingdong believes that many customers are worried that they will not be able to renew their insurance normally the following year and give up buying short-term health insurance.
Li Chunkan believes that the problem of low short-term health insurance renewal rate mainly comes from the consequences of monthly payment products being put into sale on the delivery platform in the form of "0 yuan for the first month".
There are also industry insiders who analyze that the industry's renewal rate is relatively low, and there are reasons such as product competition and low investment promotion."The homogeneous short-term health insurance such as million-dollar medical insurance is serious, while the homogeneous product has led to low customer recognition and sales are gradually declining. The traditional million-dollar medical insurance is coming to an end." The person said.
"On the one hand, some top insurance companies' ultimate cost-effective products are constantly upgraded and iterated to maintain high user trust; on the other hand, supervision has rectified the chaos in sales of compensation health insurance, and various insurance companies have begun to seize market share in a tiered manner. The medical insurance market for sub-price and senior-age groups is still potentially blank. Differentiated pricing of these groups can solve the insurance needs of this group and achieve a considerable premium scale." Regarding the market competition situation, Tang Jingdong told reporters.
It is worth noting that as healthy people develop to the limit, more and more insurance companies are beginning to pay attention to expanding the medical insurance needs of insurable people, including chronic disease and elderly people. "The compensation performance we see is obvious. Therefore, we believe that each insurance company may have differentiated product designs for their target customer base." Li Chunkan said.
According to iResearch Consulting's calculating the penetration rate of Million Medical Insurance in the target user market, the market penetration rate of Million Medical Insurance among users aged 0-65 in 2020 was only 7.4%, which is significantly lower than the 26.4% penetration rate of commercial health insurance in the entire population, indicating that Million Medical Insurance still has a lot of room for growth in user growth. It expects that medical insurance compensation accounts for 65% of commercial health insurance compensation expenditures in 2025, among which mid-to-high-end personal medical insurance, with millions of medical insurance as the main body, will play a higher performance.
Daily Economic News
