"Recently, I heard that the neighborhood of several friends around me was closed and managed, so I bought an isolation insurance. I thought that at least if I was isolated and there were thousands of yuan to take, the premium would be two cups of coffee less." Miss Gu, who has just purchased isolation insurance, told the first financial reporter.
There are not a few people who think the same as Miss Gu. In fact, with the repeated outbreaks in many cities and the continuation of prevention and control measures, isolation insurance has become a hot selling insurance in the near future. However, if you are isolated, can you settle the claim? The first financial reporter checked the terms of a variety of isolation insurance sold in the market and found that the answer was "not necessarily".
"isolation insurance" into online red
"Don't worry about isolation", "as long as 9.9 yuan, you can get 200 yuan a day", "let the insurance company pay you during the isolation period"... Under the repeated epidemic, the above marketing slogans began to appear in the circle of friends of some insurance marketers.
Throwing out these slogans is that they want to recommend a product called "isolation insurance". The essence of the so-called "isolation insurance" is "isolation allowance", which refers to the isolation allowance for specific infectious diseases paid by the insurance company during the isolation of the insured due to covid-19 epidemic.
In recent months, isolation insurance has undoubtedly become an online popular product, occupying the "hot selling position" and "recommended position" of various intermediary websites and apps. Media statistics show that at present, dozens of insurance companies have developed nearly 60 "isolation insurance". Since the fourth quarter of last year, the sales volume of "isolation insurance" has increased significantly, and the average number of insured pieces per month of a consignment platform has even exceeded 10000 pieces.
The first financial reporter checked a variety of isolation insurance in the current market and found that most of them are additional types of health insurance or accident insurance. In addition to the infectious disease isolation allowance, the whole product usually also includes general accident protection, traffic accident protection, infectious disease related protection, epidemic seedling protection, etc. The guarantee period of most products ranges from one month to one year, the premium is usually less than 100 yuan, and the isolation allowance ranges from hundreds of yuan to thousands of yuan per day.
Li Wenzhong, deputy director of the insurance Department of Capital University of economics and trade, wrote that there are two main factors for the popularity of "isolation insurance": first, under China's current epidemic prevention and control measures, a large number of people will be isolated if covid-19 virus infected or close contacts are found anywhere, which will have a certain impact on their work and life, Therefore, this isolation risk will lead to a large amount of insurance demand; Second, at present, the premium of "isolation insurance" in the market only needs a few yuan if it is low, and generally dozens of yuan if it is expensive. Once the insurance claim settlement conditions are triggered, hundreds or even thousands of yuan can be paid every day. Most people can afford the premium. The cheap premium and high leverage ratio stimulate many people's willingness to buy.
From the perspective of insurance companies, insurers also believe that the inclusion of isolation allowance into the scope of insurance liability is another exploration for insurance companies to deal with epidemic prevention and control and meet market demand after expanding covid-19 protection liability, and can give certain economic compensation to the insured for economic losses such as being unable to work due to isolation.
isolated, can you compensate for it
Although isolation insurance can bring some risk compensation to isolation life, the premise is how to meet the claim conditions of the insurance company?
In fact, a careful study of many isolation insurance clauses shows that the isolation allowance is quite demanding for "isolation". As Ms. Gu mentioned, it does not meet the compensation conditions in most products because it is isolated at home in the same community as the diagnosed or close contacts.
Take one of the best-selling products as an example. For the isolation allowance, the clause stipulates that after the two-day waiting period after the policy takes effect, the insured has close contact with covid-19 patients during the insurance period, or is notified by the local government or epidemic prevention department to implement centralized isolation or home isolation because he is in a medium and high-risk area, The insurance company shall pay the isolation allowance for specific infectious diseases according to the actual isolation days of the insured. In other words, the isolation allowance must meet one of two conditions, that is, the diagnosed person is closely connected or isolated in medium and high-risk areas, while the secondary close connection or the same community is isolated. At present, the more common situation does not meet the claim settlement requirements.
According to the observation of the first financial reporter, the claim conditions of many other similar products are more stringent, including only centralized isolation, and some isolation allowances attached to traffic accident insurance. When you have to take the means of transportation agreed in the contract, you need to force centralized isolation at your own expense because you are in close contact with the diagnosed person. In addition, global control, health monitoring and other situations are not within the scope of compensation for isolation allowance.
"It is easy to buy but difficult to compensate" makes isolation insurance the "hardest hit area" of recent complaints from the insurance industry. The first financial reporter searched with the keyword "isolation insurance" on the black cat complaint platform. As of the evening of March 7, there were 1744 relevant contents, most of which were difficult to settle claims.
An executive of a property insurance company told the first financial reporter that in order to promote sales, some insurance companies will focus on low prices and high compensation when publicizing isolation insurance, while the exemption and claim settlement restrictions are relatively diluted, which is prone to misleading. Because the insured has read the terms and conditions of the insurance, it is easy for the insured to introduce such products through the Internet. Therefore, it is easy for the insured to understand such terms and conditions, and some products are not even introduced by themselves.
Tian Jingting, a judge of Beijing Xicheng court, wrote an analysis that according to the insurance law, the insurer has the burden of proof for the prompt explanation of its exemption clause. Isolation insurance is mostly sold through the Internet. If the applicant or the agent authorized by the applicant operates according to the insurance process set on the insurer's website in the process of activating the electronic insurance policy, he can read the specific explanation of the concept, content and legal consequences of the relevant liability exemption clauses, If it is confirmed that "the insurer has fulfilled the obligation of clarification" and "the insurer has fulfilled the obligation of clarification", it can be deemed that the insurer has fulfilled the obligation of clarification of the exemption clause to the applicant in the insurance process. However, if the exemption items in the insurance terms are not marked in bold and black and other significant ways, and the insurance company fails to provide evidence to prove that it has explained the deductible items of isolation insurance to consumers, it cannot be determined that the insurance company has fulfilled its obligation to prompt and explain the exemption terms, the terms will not be effective, and the insurance company has no right to refuse compensation on this ground.
\u3000\u3000 "When purchasing insurance products, consumers should carefully study the insurance clauses, pay special attention to the insurance liability and exemption clauses, clarify the meaning of 'isolation', and carefully make insurance decisions according to their own needs. After the occurrence of insurance accidents, keep the certificates such as isolation notice and isolation fee payment, and notify the insurance company in time. At the same time, the insurance company should deal with isolation when selling isolation insurance The insurance liability and exemption of the insurance shall be brought to the attention of consumers in a significant way and clearly explained. The compensation content of isolation insurance shall be accurately described in the website publicity to guide consumers to apply for insurance rationally. " Tian Jingting suggested.
In addition to the difficulty in settling claims, the first financial reporter noted on the complaint platform that the high-frequency complaints involved in isolation insurance also include disputes caused by the different identification of the start time of the isolation period between the applicant and the insurance company; And the bundling sale of isolation insurance with air tickets, train tickets, etc.
embark on the road of standardization
All kinds of chaos caused by isolation insurance in the process of great heat has also attracted the attention of regulators.
At the end of January this year, the China Banking and Insurance Regulatory Commission issued the "urgent notice on regulating the operation of" isolation "allowance insurance business" (hereinafter referred to as the "notice"), which directly pointed to the pain points of isolation insurance in the sales process.
The notice requires insurance companies to correct their business philosophy. In the process of developing and designing insurance products, they should earnestly take the people as the center, take the actual needs of insurance consumers as the basis, comprehensively consider the insurable benefits and risk degree, develop products according to laws and regulations, and reasonably set the conditions for exemption of liability and settlement of claims.
At the same time, in the process of publicity and sales, insurance companies are required not to make misleading publicity or explanations on important situations such as the guarantee liability of insurance products by means of deception, concealment or inducement, and not to conduct one-sided publicity and malicious exaggeration and speculation for the purpose of attracting the attention of consumers; And fully explain the insurance liability, liability exemption and claim settlement conditions, and make tips and explanations sufficient to attract the attention of the applicant for the terms of exemption of the insurer's liability in accordance with the law and regulations.
\u3000\u3000 "After the regulatory notice was issued, I felt that the isolation insurance in the market was more standardized, and some exaggerated propaganda words such as' 0 yuan in the first month 'basically disappeared. In fact, this is a good innovative product, which has a certain insurance demand and risk protection value in this special period. It is not a' gimmick 'product. If it is screwed up due to some improper sales behavior, it will be better than It's a pity. At the same time, we also hope that the insured can choose products rationally and carefully check the terms when purchasing, so as to avoid disputes after deviation in understanding. " The above property insurance company executives said.
The first financial reporter found that at present, isolation insurance products have set up "special tips" at the top of the introduction page, and "bold red" has been carried out for some main situations that are not insurable and not compensated.
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