The recently published People's Daily, with the title of "Extending Insurance Services to Better Protect People's Livelihood", reported that Chinese Life gives full play to the functions of insurance economic shock absorber and social stabilizer, continuously enhances the accessibility, convenience and accuracy of insurance services, helps improve the efficiency of social governance, holds the bottom line of people's livelihood with precision, and protects people's better life with heart and affection.
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Picture (1): In Suzhou Guoshou Jiayuan Suzhou Yajing Retirement Community, the elderly are taking hand-knitting classes.
Figure (2): The staff explained to residents the relevant situation of the inclusive insurance product "Chongqing Yu Kuaibao".
General Secretary Xi Jinping stressed: "It is necessary to strengthen the problem-orientation, pay close attention to the worries, worries, and worries that the people have strong reactions to in social security, and pay close attention to the hard bones that restrict the construction of the social security system, and constantly promote reform." ”
In recent years, the insurance industry has continuously strengthened cooperation with medical insurance, civil affairs and other departments and related fields in combination with the actual needs of people's health and pension, actively participated in various inclusive insurance projects led by the government, and continuously expanded service content, helping to improve the efficiency of social governance, and ensuring the bottom line of people's livelihood. What are the highlights of these innovative practices? The reporter conducted interviews in Jiangsu, Chongqing and other places.
The inclusive insurance project is in-depth and detailed
Innovate services based on the actual needs of the people
The grandmother-in-law, who lives in Xiangcheng District, Suzhou City, Jiangsu Province, is over eighty years old. In March this year, she accidentally fell at home and injured her back, and the hospitalization cost was nearly 30,000 yuan, and the self-paid part was more than 6,100 yuan. Suzhou Accident Comprehensive Insurance for the Elderly gave Grandma a "warmth". Not long after being discharged from the hospital, the family applied for insurance compensation of 5,136.34 yuan for my grandmother-in-law, including 4,996.34 yuan for medical expenses and 140 yuan for hospitalization, and the proportion of self-paid compensation exceeded 83%.
71-year-old Grandma Qian also felt the thoughtfulness and convenience of Suzhou Accident Comprehensive Insurance for the Elderly not long ago. "On March 30 this year, I was hospitalized with injuries from a fall and was discharged in early April. The staff of the insurance company took the initiative to contact me and taught me to use the 'Su Zhoudao' mobile app to apply for 'one-click quick compensation', and the compensation of more than 800 yuan arrived in 2 hours. This 'unexpected' compensation made me feel that society is becoming more and more concerned about the elderly. ”
"Suzhou Accident Injury Comprehensive Insurance for the Elderly adopts the form of government funding and social management, and the government uniformly insures the elderly over 60 years old with local household registration, provides accidental medical compensation and hospitalization allowance, and reduces the economic losses caused by accidental injuries to the elderly and their families." Yan Qiang, deputy director of the Suzhou Civil Affairs Bureau, said that at present, the project covers more than 2 million elderly people in Suzhou, and a total of 113,800 elderly people have received claims of more than 200 million yuan.
In recent years, more and more inclusive insurance projects have been led by the government and handled by insurance institutions, and many localities have launched government-insurance cooperation projects such as rural small-amount life insurance, maternity care and women's health insurance, so as to increase the protection of farmers, women, the elderly and other groups.
"The insurance industry has the advantages of professional ability, personnel strength and service network, and it is necessary to guide it to further participate in social governance, play a greater role in the multi-level medical security system and multi-level old-age security system, and better protect and improve people's livelihood." Wang Xiangnan, deputy director of the Insurance and Economic Development Research Center of the Chinese Academy of Social Sciences, said.
The participation of the insurance industry in the operation of inclusive insurance projects is also conducive to further identifying the entry point of serving people's livelihood and realizing the unity of social and economic benefits.
In the Jingrui Rongyu Lanwan Community in Taicang City, Suzhou, Grandma Yu, who lives on the second floor, goes to the terrace every day to water the flowers and bask in the sun. From the house to the terrace, there are several steps to walk, and as she grows older, Grandma Yu gradually feels difficult. Not long ago, Grandma Yu listened to the staff of the insurance company in the community to tell her that she could install handrails at home for free, and she immediately applied for it. "Soon someone came and installed a small handrail on the wall next to the steps. Nowadays, it comes in handy. "Grandma Yu was very happy.
Yuan Xin, deputy general manager of Suzhou Branch of Chinese Life Insurance Co., Ltd., the manager of Suzhou Accident Injury Comprehensive Insurance for the Elderly, said that the company's research project insurance claims found that the elderly have a high proportion of indoor falls and fractures, and serious complications may occur. In this regard, the company has piloted the installation of handrails for the elderly in Taicang City and other places to reduce the risk of injury for the elderly from the source. This is not only conducive to improving the quality of life of the elderly, but also reducing the probability of insurance for insurance companies and realizing the long-term stable operation of inclusive projects.
As of the end of April this year, the company has installed handrails for nearly 300 households according to the needs of residents, most of which are toilets and bathing areas. The project will also be implemented in other districts and counties of Suzhou, so that more families can enjoy services that benefit people's livelihood and warm people's hearts, and also guide more families and the public to pay more attention and care for the elderly. Yuan Xin said.
"The essential attribute of insurance is to provide risk protection. Insurance institutions should continue to have a deep understanding of people's livelihood and continue to explore ways to provide diversified and high-quality services to help people reduce various accident risks. Wang Xiangnan said.
Strengthen collaboration and data sharing
Improve the quality and efficiency of insurance services
In the inclusive insurance project, the insurance industry has continuously optimized product design and expanded services by giving full play to its professional advantages, and has also improved the quality and efficiency of its claims settlement and operation level by strengthening coordination and data sharing with various departments and fields.
Sister Wang, a citizen of Chongqing, experienced the novelty of "non-inductive claims" in medical insurance. "During the check-up, I was diagnosed with breast cancer. During the treatment process, the previously insured Huimin Insurance product 'Chongqing Yu Kuaibao' not only compensated for part of the expenses, but also connected to the basic medical insurance, realizing 'no sense of claim' when discharged from the hospital. The insurance money can be directly deducted from medical expenses, which not only reduces the financial pressure compared with the traditional way of paying first and then reimbursing, but also saves the trouble of collecting the materials required to apply for a claim. Sister Wang said.
"Chongqing Yu Kuaibao" can achieve convenient claims, which plays an important role in multi-field coordination and strengthening data sharing. It is understood that the Chongqing Supervision Bureau of the State Administration of Financial Supervision and Administration has established a comprehensive financial service network of "data sharing + business collaboration" - Jinyu.com, as an incubation platform for local financial infrastructure and various digital financial application scenarios, to help improve the convenience level of services such as "Chongqing Chongqing Quick Insurance".
"We cooperate with the Chongqing Municipal Medical Insurance Bureau to promote the docking of the 'Chongqing Yu Kuaibao' integrated service platform with the basic medical insurance system, realize real-time settlement and synchronous billing in different business scenarios of basic medical insurance and commercial insurance, and establish a reconciliation and payment mechanism for claims, so that insured patients do not need to pay the corresponding amount of claims when they are discharged from the hospital, and the insurance company and the hospital will settle the settlement. In order to ensure the security of medical insurance data, the relevant data is connected through the special line of Jinyu network, and all the original data of medical insurance does not leave the domain, effectively avoiding the risk of data leakage and secondary development. Jin Yanfang, director of the Life Insurance Division of the Chongqing Supervision Bureau of the State Financial Supervision and Administration of the People's Republic of China, said.
The notice of the National Data Bureau and other departments on the issuance of the "Data Element ×" Three-Year Action Plan (2024-2026) proposes to explore and promote the integration and application of medical insurance and commercial health insurance data in accordance with laws and regulations, improve the level of insurance services, and promote the coordinated development of basic medical insurance and commercial health insurance. According to experts, for insurance institutions, high-quality data is an important foundation for achieving accurate insurance pricing. Under the standardized operation and supervision of relevant departments, the sharing of medical insurance data with commercial insurance institutions is also conducive to promoting the accurate pricing of insurance products, enhancing inclusiveness, and forming an effective connection with basic medical insurance.
According to the data, in 2023, the number of insured people in "Chongqing Yu Kuaibao" will exceed 6.2 million. In addition, the deductible of this insurance is also relatively low among Huimin Insurance products, and the protection capacity continues to improve. At present, "Chongqing Yu Kuaibao" has accumulated more than 1.3 million claims, and the cumulative compensation amount has exceeded 1.3 billion yuan.
The "Insurance+" cooperation model has been implemented in more and more fields, continuously improving the convenience of financial services. Chongqing Municipal Public Security Bureau and Chongqing Insurance Industry Association jointly launched the "Traffic Patrol Police + Auto Insurance Claim" integrated inquiry service, if a driver applies for a car insurance claim in the event of a traffic accident, he can log in to the Chongqing Public Security "Police Quick Office" WeChat public account, click "Auto Insurance Claim Inquiry" in the "Traffic Patrol Police Area", quickly query the vehicle traffic accident claim information under his name, keep abreast of the progress of the claim, and effectively prevent the owner from being fraudulently used by criminals without knowing it. In addition, the relevant departments actively promote the integration of auto insurance claims services in Chengdu and Chongqing, and the non-personal injury claims of auto insurance in Chengdu and Chongqing can be completed within an average of 7 working days.
"On the premise of ensuring data security and data desensitization, the efficient integration and application of economic activity data, financial data and government affairs data is conducive to promoting the financial industry to provide high-quality services for the real economy and social livelihood." The relevant person in charge of the Chongqing Supervision Bureau of the State Financial Supervision and Administration said.
Helping to improve the level of social insurance services
Ensure the safe and efficient use of funds
In the service hall of Nanjing Medical Insurance Center, located on Shuiximen Street in Jianye District, Nanjing, an AI medical insurance service robot is helping residents handle business. According to the staff of the hall, this equipment is directly connected to the medical insurance system and has entered 3,000 pieces of medical insurance business-related information, and residents can carry out policy consultation, business handling, query and printing through this machine, which not only improves the efficiency of the citizens, but also reduces the load on the window, and is welcomed by the public.
It is understood that the AI medical insurance service robot was jointly built by the Nanjing medical insurance department, Nanjing Branch of Chinese Life Insurance Co., Ltd., information technology companies, etc., and was put into use in the service hall of the medical insurance center and the main business outlets of insurance institutions, improving the accessibility and convenience of medical insurance services. At present, the AI medical insurance service robot has handled more than 56,100 medical insurance businesses, with an average of more than 2,950 cases per month.
Qian Guorong, a member of the party group and director of the medical insurance center of Nanjing Medical Insurance Bureau, said that the local government actively plays the role of market mechanism, makes full use of the technical resources and professional service advantages of commercial insurance institutions, promotes commercial insurance institutions to better integrate into the multi-level medical security system, and actively cooperates with the medical insurance department in handling services, audit and audit, innovation and development, etc., continuously expands the scope of cooperation, expands cooperation methods, and jointly builds a service model of "medical insurance management as the mainstay, extension point handling as a supplement, and commercial insurance handling as a supplement".
"For example, commercial insurance institutions, as the contractor of critical illness insurance, participate in the establishment of a professional critical illness insurance audit team, through data analysis, intelligent monitoring, medical record review, on-site audit and other means, timely find and deal with problems, ensure the safe and effective use of critical illness insurance funds, and effectively maintain the safety and stability of the medical insurance fund." Qian Guorong said that this has provided strong support for the medical insurance department to improve the treatment of serious illness insurance. In recent years, the minimum payment standard of critical illness insurance in Nanjing has dropped from 20,000 yuan to 15,000 yuan, and the reimbursement ratio of critical illness insurance has remained above 60%.
The role of social forces such as the insurance industry in handling social security services is becoming increasingly apparent. The report of the 20th National Congress of the Communist Party of China clearly proposed the establishment of a long-term care insurance system. From the perspective of local practice, in the process of handling long-term care insurance projects, known as the "sixth social security insurance", local agencies play an important role in the assessment of the level of disabled persons, care services and assistive device services, as well as strengthening the application of scientific and technological means to prevent funds from leaking.
"The introduction of commercial insurance institutions to provide services by the competent social insurance authorities through agreements and cooperation can improve the quality and efficiency of services to a certain extent. In the future, it is necessary to promote the insurance industry to be better embedded in the national basic public service system, improve the level of service supply in the fields of medical health and old-age security, reduce government management costs, and promote the insurance industry to better play the role of economic shock absorber and social stabilizer. Wang Xiangnan said.