Recently, Chinese Life Insurance Co., Ltd. (hereinafter referred to as "Chinese Life Insurance Company") released the 2023 Life Insurance Claims Service Report. According to the report, the company's annual claims were 22.13 million, a year-on-year increase of 15.5%, and the amount of claims was 59.9 billion yuan, a year-on-year increase of 16.3%, with a probability of 99.7%. At the same time, it has assumed the responsibility of waiving insurance premiums for 88,000 policies, with a total of nearly 940 million yuan of insurance premiums waived for customers, and customers who have waived insurance premiums can still enjoy insurance protection.
Chinese Life Insurance Company has released claims service reports every year in recent years, and this year's report updates the latest data on life insurance claims, refreshing our understanding of the value of insurance professional services, telling insurance users the insurance concept worth paying attention to, and prompting us to pay attention to important information about personal protection, including: the speed of insurance claims is constantly improving; insurance customers will get insurance "rapid response" in the emergency treatment of emergencies; how to provide themselves with quality and healthy life protection through commercial insurance.
The speed of insurance claims is increasing
Demonstrate exceptional service levels
"Critical Illness One-Day Claim" is a service initiative launched by Chinese Life Insurance Company, which provides eligible customers who apply for critical illness compensation with a service to complete claim processing within one working day, realizing "diagnosis can be claimed", and effectively improving customer claim service experience and service efficiency. At present, the "One-Day Critical Illness Claim" has covered malignant tumors and some cardiovascular and cerebrovascular diseases, which account for the highest proportion of critical illness claims.
According to the company's latest claims service report, in 2023, 244,000 "one-day claims for critical illness" will be paid, with a compensation amount of nearly 11.2 billion yuan, and nearly 95% of the critical illness claims that meet the standards can be paid in one day. The comparison found that the amount of "one-day compensation for critical illness" in 2023 was 1.51 times that of 7.4 billion yuan in 2021.
Insurance claims are the key to the insurance company's performance of its obligations under the insurance contract, and it is also an important indicator to measure the insurance company's operational service capabilities. The company's claims report shows that in 2023, Chinese Life Insurance Company will launch a "claim prepayment" service initiative, breaking the traditional model of "claim settlement after medical treatment" and sending insurance protection in advance to customers in the process of medical treatment. Traditional claims require customers to be discharged from the hospital and settled by social security before they can apply for a claim, but many customers can no longer support the high medical expenses during their hospitalization, resulting in the double pressure of illness and finance. Chinese Life Insurance Company pays attention to the needs of customers, practices the development idea of "people-centered", and carries out "claims prepayment" services, in which the "hospitalization prepayment" scenario can pay compensation in advance for eligible customers during medical treatment to relieve customers' medical pressure. In 2023, Chinese Life Insurance Company will settle nearly 28,000 prepaid claims, with a compensation amount of nearly 500 million yuan, which has been widely praised by customers.
Claims settlement speed is an important touchpoint for customers to perceive claims service. Chinese Life Insurance Company focuses on customer needs and continuously improves the speed of claims settlement. According to the claims report of Chinese Life Insurance Company, the company's overall claim time limit in 2023 is 0.38 days, an increase of nearly 12% year-on-year.
Respond to emergencies as soon as possible
In the face of risk, there is more strength and solace
The economic compensation function of insurance is the most fundamental function of insurance, and it is also the most fundamental feature that distinguishes insurance from other industries. The concept of life insurance is to reduce the risk of hitting individuals and families in times of crisis, and become the most reliable companionship, help and comfort for customers in difficult times.
According to the claims service report of Chinese Life Insurance Company, in 2023, the company responded to 178 emergencies in the first time, such as: 6.2 magnitude earthquake in Jishishan County, Linxia Prefecture, Gansu Province, Lüliang Yongju coal industry fire accident in Shanxi, Jinyang flood in Liangshan, Sichuan, 5.5 magnitude earthquake in Pingyuan County, Dezhou City, Shandong, heavy rainfall disaster in Beijing-Tianjin-Hebei region, etc. Chinese Life Insurance Company provides warm service to customers besieged by disasters and accidents.
The emergency response to claims emergencies often requires high timeliness, affects a wide range of groups, and has a large social impact, which forms a major test for the service ability of insurance companies, and is an important embodiment of the insurance industry's fulfillment of social responsibility and acting as a social "stabilizer".
In 2008, a strong earthquake of magnitude 8.0 struck Wenchuan County, Sichuan Province, causing heavy casualties. Chinese Life Insurance Company immediately activated the emergency response mechanism and issued ten "Chinese Life 5.12 Earthquake Insurance Claims Service Commitments". More than 300 claims experts from more than 30 provinces traveled thousands of miles to help, braved the danger of aftershocks, went against the grain to carry out earthquake claim assistance, and established 69 claim service stations in Yingxiu Town, Beichuan County and other disaster areas to provide fast and warm services to customers who came to consult. According to post-disaster statistics, Chinese Life Insurance Company sent more than 16,000 cases to the front-line claims assistance team in the disaster area, and paid more than 150 million yuan in compensation, making it the life insurance company with the largest claim settlement volume in the Wenchuan earthquake.
Over the years, Chinese Life Insurance Company has continuously based on practical experience and gradually explored a set of "system + management + service" as the core, efficient and three-dimensional "emergency express compensation" service system, covering efficient response to claims emergencies, organizational system, division of responsibilities, service measures, data control, as well as efficient coordination and service guarantee with relevant government departments, so that the company can respond to emergencies quickly, scientifically and orderly, and provide all-round, One-stop integrated services to effectively protect the interests of customers.
Applying this emergency claims service system, at the beginning of the outbreak of the new crown epidemic in 2020, Chinese Life Insurance Company activated the claims emergency mechanism as soon as possible, comprehensively promoted the "contactless service" of claims, opened a 7×24-hour online claim application channel, simplified the claims procedures and processes, and accelerated the processing timeliness. During the epidemic period, the initiative of "contacting customers within one hour after reporting the case, and processing it within one day after receiving all the materials in principle" was launched.
Chinese Life Insurance Company has built a "Great Wall" against disasters with professionalism and warmth. Behind this is the company's deep cultivation of online and offline management processes and the use of technology to promote the reform of claims services.
Since 2023, Chinese Life Insurance Company has piloted "no manual claims in the whole process" in many provinces, reducing manual operation time by more than 90%, and the proportion of automatic claims in pilot areas has reached 5%-15%. In 2023, the number of claims directly paid by Chinese Life Insurance Company will exceed 7.27 million, with a compensation amount of nearly 5 billion yuan, and the fastest can reach second-level claims. The so-called "second-level claim" means that when the customer is discharged from the hospital to settle the medical expenses, the insurance money is calculated and paid in real time through the direct connection between the data of medical insurance and commercial insurance, and the medical expenses are directly deducted.
Chinese Life Insurance Company continues to innovate the claims service model, constantly refresh the claim settlement speed with cutting-edge technologies such as mobile Internet, big data, cloud computing, artificial intelligence, etc., focus on customer claim experience, and is committed to providing customers with a simple, high-quality and warm service experience. The company is the first in the industry to launch medical electronic invoices, which are applied in the claim settlement process, realizing the transformation of electronic bills into data and the transformation of claims service from passive to active. In 2023, its electronic invoice claims will be nearly 5.08 million cases, with a compensation amount of more than 5.3 billion yuan, and the compensation time limit will only be 0.3 days, while the electronic invoice will remind the number of claims reported to be 567,000 cases, with a compensation amount of more than 600 million yuan, and a compensation time limit of 0.14 days.
After the settlement of the claim, a customer sincerely sighed: "The current insurance claims completely refresh the understanding of traditional insurance companies, and feel that the power of technology makes insurance more secure, more professional and more trustworthy; compared with the previous medical insurance reimbursement process, the commercial insurance claims process represented by Chinese Life is clear, the operation is simple, and the claim payment is even more immediate." ”
One "good news" and one "bad news"
China Life's claims data gives us insight into health trends
The Chinese Life Insurance Company's claims service report also provides us with two new dimensions of thinking:
One is "bad news". The detection rate of critical illnesses in people aged 25-45 underwritten by the company has increased from 6.3 per 10,000 in 2013 to 12 per 10,000 in 2022. Critical illness claims are becoming younger.
The other is "good news". Claims data also shows that with the continuous improvement of medical standards, the 5-year survival rate of critical illness customers continues to increase. Therefore, critical illness insurance is not only used to cover the cost of critical illness treatment in the traditional sense, but more importantly, it is used to maintain the quality of life after suffering from critical illness.
On the one hand, the trend of customers gradually advancing the detection time of critical illness reminds us to equip sufficient critical illness protection in advance, so as to better build a risk bottom line for our healthy life. On the other hand, the continuous improvement of the 5-year survival rate after the diagnosis of critical illness also makes us rethink whether there is an insurance product with sufficient coverage that can provide sufficient treatment costs, which has the ability to allow the insured to enjoy better medical conditions and prolong the life of patients.
The reality reflects the data that for patients with serious illnesses, the medical expenses after medical insurance reimbursement are still a large expense. The claim data of two typical medical insurances of Chinese Life Insurance Company shows that with the improvement of people's risk awareness, the per capita compensation amount among people suffering from common serious diseases has shown a steady upward trend, and the per capita compensation amount in 2023 will be nearly 30,000 yuan, which can cover 60%-80% of the out-of-pocket expenses after medical insurance reimbursement, and sufficient medical protection can better ensure the demand for disease treatment.
To a certain extent, preparing commercial insurance in advance is an important plan and long-term investment for us and our family's future living standards.