Insurance is paid out. In the annual claim settlement report of insurance companies, the claim data weave out a risk map. According to the incomplete statistics of China first finance and economics, as of January 26, at least 60 insurance companies had disclosed their 2021 claim settlement reports, and the premier’s compensation amount exceeded 232.6 billion yuan.
What risk trends are outlined behind these 232.6 billion yuan? By combing some of the claim settlement reports, the first financial reporter found that malignant tumors, myocardial infarction and cerebrovascular diseases have been the top three “health killers” in recent years, but the risk rate of serious diseases has increased, while the age of diagnosis has decreased.
trend 1: young people in danger of serious diseases
Among the total compensation of 232.6 billion yuan, the compensation of six listed life insurance companies was 146.9 billion yuan, accounting for more than 60%, with a year-on-year growth rate of 6.3% – 31%. This growth rate is obviously higher than the growth rate of premium income of six listed life insurance companies in 2021. China Life Insurance Company Limited(601628) the claim settlement report shows that from 2017 to 2021, the number of serious illness compensation paid by the company increased from 220000 to 400000, and the total compensation also increased from 7.2 billion yuan to 16.3 billion yuan, an increase of more than 120% in five years.
According to the claim settlement reports of six listed life insurance companies, the total claims of serious illness insurance and medical insurance are “big heads”, accounting for more than 70% of their total claims.
Source: first finance sorted out according to the claim settlement report
Almost all claims for life insurance reports reveal the incidence rate of serious diseases and the younger diagnosis. Combing the age groups of serious diseases of six listed life insurance companies, 41-60 years old is the most concentrated age group. The World Health Organization calls the decade of 46-55 years old “high-risk period of life”. During this decade, it was a high incidence stage of most diseases such as cardiovascular and cerebrovascular diseases and cancer. Now, the risk rate of serious diseases among people aged 41-46 and younger is also rising.
The claim settlement report of China Life Insurance Company Limited(601628) shows that compared with 2017, the risk rate of major diseases among people over the age of 18 shows an upward and younger trend. Among them, the risk of major diseases of the 40 year old population with “old people at the top and small people at the bottom” has increased significantly. This group is also the “hardest hit area” for the settlement of serious disease claims. They are often the main source of income of families. Once they suffer from serious disease and lead to the interruption of family income, it will have a great destructive force on family finance.
Source: China Life Insurance Company Limited(601628)
The insured group from the Internet platform is younger due to its low overall age.
Tencent Weibo health insurance claims data show that men aged 46 to 50 and women aged 41 to 45 are the most concentrated age group for serious illness, which is significantly ahead of the above “high-risk life period”. According to the data of the National Cancer Registration Center, in 2000, there were about 40 tumors per 100000 young people aged 20 to 39. In 2013, the number became 70, and the data increased by 80%. It can be seen that malignant tumors show a younger trend, which should not be underestimated.
A claim adjuster of a life insurance company told the first financial reporter that there are many factors causing the increase and rejuvenation of the risk rate of serious diseases, mainly due to changes in the environment and the impact of pressure. In addition, due to the progress of medical level, the detection rate of serious diseases has made a leap forward compared with a few years ago, In addition, everyone’s awareness of physical examination and the medical welfare of enterprises have also been greatly improved, making it easier for serious diseases to be found and diagnosed.
trend 2: the top three “health killers” of different insurance companies are similar, and the risk rate of women’s serious diseases is higher
What are the “health killers” behind the rise in the incidence of serious diseases?
Although the claim settlement data of various insurance companies are different, the “health killers” disclosed by large insurance companies are surprisingly consistent. From the five listed life insurance companies that disclosed the top three causes of serious diseases, malignant tumors, cardiovascular diseases and cerebrovascular diseases were ranked in the top three, among which malignant tumors are still the “number one killer” of human health. In addition to malignant tumors, respiratory diseases, digestive diseases and circulatory diseases are all diseases that customers need to focus on prevention and attention.
Among malignant tumors, the top three women in the six listed life insurance companies are also surprisingly consistent, all of which are thyroid, breast and lung; In the top three male accident rates, the ranking is different, but it is basically concentrated in the four parts of thyroid, lung, intestine and liver.
The compensation report of PICC counts the high incidence areas of outpatient insurance claims. Bronchitis, acute upper respiratory tract infection and irregular menstruation are high incidence outpatient diseases. Weibo said that contemporary people have increased pressure on work and life. Irregular diet and staying up late have become the norm for many people. For a long time, the body will send danger signals, and even outpatient minor diseases should be vigilant.
In addition to the convergence of “health killers”, another common feature of the claims reports of several listed life insurance companies is that women’s claims for serious illness insurance are higher than men’s.
The claim settlement data of Ping An Life Insurance shows that in the proportion of malignant tumor compensation, the proportion of women to men is 69:31; In the settlement of serious illness insurance claims of Taiping Life Insurance, the number of female claims in the two major ranges of 18-40 years old and 41-60 years old is 68.8% and 59.7% respectively; Women accounted for 59.49% and 57% of the total serious illness compensation of Xinhua life and CPIC life respectively. Similarly, the claim settlement data of Zhong’an health insurance also shows that in 2021, female users accounted for 53.8%, slightly higher than men. Insurance companies remind that women need to be equipped with adequate security and do a good job in regular screening.
trend 3: the amount of serious illness guarantee is seriously insufficient
After the outbreak, the industry generally believed that people’s insurance awareness had been strengthened. But as far as insurance products are concerned, there is still a big difference between “bought” and “bought enough”. From the claim data of insurance companies, the average claim amount of people is still stretched compared with the average treatment and rehabilitation cost of major diseases.
According to the claim settlement data in 2021, there are about 400000 serious illness claims, with a payment amount of 16.3 billion yuan and 40700 yuan for each case, which is a large gap compared with the current average amount of 100000-500000 yuan for the treatment and rehabilitation of major diseases.
The claim settlement data of sunshine life also shows that there is a huge gap between the compensation amount of major disease insurance and the actual treatment expenses. The amount of serious disease protection of more than half of customers is not enough to support the minimum cost standard of treatment, which does not include the expensive expenses required for later rehabilitation and treatment.
Source: sunshine life
From the perspective of the amount of serious illness claims of Taiping Life Insurance, nearly 30% are concentrated in the low range of RMB 0-50000, while the number of serious illness insurance claims of more than 500000 accounts for only 3%, and the guarantee gap of serious illness insurance is huge.
Source: TPL
“In recent years, China’s medical inflation rate is much higher than the average economic inflation rate, which means that the cost of health investment will be greatly increased in the future, and adequate insurance is essential. The amount of insurance for people aged 41-60 with high incidence of serious diseases is obviously insufficient.” PICC Life Insurance said.
Industry insiders suggested that we should gradually change from the concept of “whether there is security” to “whether the security is enough and whether the insurance amount is sufficient”. Only with sufficient serious disease security can we effectively resist health risks.
trend 4: the rise of new types of insurance such as million medical
In addition to the traditional “big head” serious illness insurance in the settlement of claims by large insurance enterprises, the rise of millions of medical insurance also makes the role of medical and health insurance in the settlement report more and more important.
According to the claim settlement data of China Life Insurance Company Limited(601628) , with the popularity of millions of medical insurance and other types of insurance, the total amount of medical compensation shows an increasing trend, with a five-year growth rate of more than 38%.
Source: China Life Insurance Company Limited(601628)
China Life Insurance Company Limited(601628) said that the premium of one million medical products is 2.5 times that of ordinary medical products, but the average compensation amount can be up to 10 times that of ordinary medical products, which has the characteristics of high insurance amount, relatively low premium and wide liability coverage. In 2021, the per capita premium of one million medical insurance is 650 yuan and that of personal general medical products is 260 yuan; However, the per capita claim amount is 21700 yuan for the former and 2200 yuan for the latter. The maximum compensation for the same customer is 68 times, and the cumulative maximum compensation for the same customer exceeds 2 million yuan.
The commercial medical insurance represented by million medical insurance seems to have become a powerful supplement to social security. Among the millions of medical bills of Taikang online in 2021, social security payment accounted for 46%, while commercial insurance payment accounted for 30%. Specifically, medical expenses are mainly concentrated in drug expenses, nursing expenses, examination expenses, treatment expenses and operation expenses; The three departments that spend the most on users’ medical bills are ICU (70000 yuan), thoracic surgery (24000 yuan) and Neurology (22000 yuan).
In terms of property insurance, the micro insurance platform shows that in addition to health insurance and automobile insurance, the number of pet owners who insured and settled claims for pets increased significantly in 2021. With the continuous improvement of people’s living standards, more and more pet breeders regard pets as part of their families.
According to incomplete statistics, the scale of China’s pet market has reached 100 billion yuan. Data show that pet users spend an average of 5561 yuan per year on a single pet. Through the micro insurance claim settlement service report, we can see that pet medical expenses account for 17% – 26% of the total pet expenses, of which the average medical expenses of pet cats are as high as 1423 yuan, and the average medical expenses of pet dogs are about 918 yuan.
trend 5: Technology empowerment, claims in seconds
“Difficult and slow claims settlement” has always been a pain point perplexing insurance users, but in recent years, the blessing of science and technology has made the original slightly lengthy claim settlement process that needs to be pulled back and forth to hand in data, feedback and supplement data more efficient.
In the individual business claim settlement cases of The Pacific Securities Co.Ltd(601099) life insurance, self-service claim settlement accounts for more than 86%. AI intelligent audit 473000 pieces, with an average aging of 3.5 seconds.
In fact, the importance of AI, artificial intelligence and related technologies in claims cases is increasing year by year. China Life Insurance Company Limited(601628) intelligent operation accounted for more than 70%, and intelligent processing of claim cases exceeded 13.9 million, a year-on-year increase of 23%; In 2021, Ping An Life Insurance used intelligent claims to settle more than 1.5 million claims, with an amount of more than 3.3 billion yuan; In 2021, there were 446900 AI intelligent claim cases of Xinhua life insurance, with a compensation amount of 972 million yuan.
Zhong’an insurance combed the whole process of intelligent claim settlement. After customers upload claim settlement materials through app, the intelligent screening system can achieve OCR automatic graphic recognition and NLP natural semantic analysis. More than 90% of claim settlement cases can achieve that customers do not need to make up after submitting claim settlement materials at one time. At present, its health insurance has a claim settlement every 28 seconds on average. 95% of the claims are applied online, and the waiting time for customers to receive claims is reduced by 57% year-on-year.
Relying on the continuous iteration of the platform’s scientific and technological capabilities, it can be predicted that the claim settlement service process will continue to be reshaped, and the claim settlement will become more and more convenient.
