《证券日报》记者近期获悉,银保监会于1月6日向各人身保险公司、各财产保险公司、中国保险行业协会下发了《关于规范短期健康保险业务有关问题的通知(征求意见稿)》(简称“意见稿”),并要求各机构于1月20日前反馈意见。

The 《 Securities Daily recently learned that on January 6, the CBRC issued a notice on issues related to the regulation of short-term health insurance business to all personal insurance companies, property insurance companies and the China Insurance Industry Association.

  记者发现,备受保险行业及投保人关注的是,该意见稿规范了对短期健康险(业内也称“网红百万医疗险”)的停售与续保要求,明确提到保险公司开发的“短期健康险产品应当在保险条款中明确表述为‘非保证续保’条款”,以及“保险公司不得随意停售在售的短期健康保险产品,侵害保险消费者权益”。

Reporters found that the insurance industry and policy-holders concerned that the draft regulation of short-term health insurance (also known as \"net red million medical insurance \") sales and renewal requirements, explicitly mentioned that the insurance companies developed\" short-term health insurance products should be clearly stated in the insurance clause as'non-insurance renewal' clause,\" as well as \"insurance companies may not arbitrarily stop selling short-term health insurance products to infringe the rights and interests of insurance consumers.

  健康险由重疾险、医疗险、长期护理险和失能险四大险种构成,这4个险种承担了健康诊疗各个阶段的不同功能,互为补充。

Health insurance consists of four major types of insurance: heavy health insurance, medical insurance, long-term care insurance and disability insurance.

  而短期健康保险,是指向个人销售的保险期间为一年及一年以下且不含有保证续保条款的健康保险产品。市面上该类保险主要以短期医疗险为主,由于其具有保费低、保额高(保额超过100万元或更高)、线上购买便捷等特点,一经推出便迅速受到消费者追捧,成为保险产品中的“网红”。

Short-term health insurance is a health insurance product that is sold to individuals for a period of one year or less and does not contain a guaranteed renewal. This kind of insurance is mainly short-term medical insurance on the market, because it has the characteristics of low premium, high coverage (more than 1 million yuan or more), easy to buy online, etc., once launched, it is quickly sought after by consumers, becoming the \"network red person\" in insurance products.

  其中,就续保这一问题,意见稿明确,保险公司开发的短期健康保险产品中包含续保责任的,应当在保险条款中明确表述为“非保证续保”条款。

Among them, on the issue of renewal of insurance, the draft opinion is clear, insurance companies developed short-term health insurance products including insurance liability, should be clearly stated in the insurance clause as \"non-guaranteed renewal\" clause.

  而非保证续保条款中应当包含以下表述:本产品保险期间为一年(或不超过一年)。保险期间届满,投保人需要重新向保险公司申请投保本产品,交纳保险费,并获得新的保险合同。保险公司不得在短期健康保险产品条款、宣传材料中使用“连续投保”“自动续保”“承诺续保”“终身限额”等易与长期健康保险混淆的词句。

The term of this product insurance shall be one year (or not more than one year). At the end of the insurance period, the applicant needs to reapply to the insurance company to insure the product, pay the insurance premium, and obtain a new insurance contract. Insurance companies are not allowed to use words such as \"continuous insurance \",\" automatic renewal \",\" promise renewal \",\" lifetime limit\" and other words that are easily confused with long-term health insurance in short-term health insurance product terms, publicity materials.

  就投保人关心的随意停售这一症结问题,意见稿提到,保险公司不得随意停售在售的短期健康保险产品,侵害保险消费者权益。保险公司停售短期健康保险产品的,应当将停售的具体原因、具体时间,以及后续服务措施等信息通过公司官网、销售渠道,以及报刊、即时通讯等便于公众知晓的方式披露告知保险消费者,并为已购买产品的保险消费者在保险期间内继续提供保障服务,在保险期间届满时提供必要且合理的转保服务。

On the policy-holder's concern to stop the sale of the crux of the issue, the draft notes that insurance companies are not allowed to stop the sale of short-term health insurance products, infringement of the rights and interests of insurance consumers. Where an insurance company stops selling short-term health insurance products, it shall inform the insured consumers through the company's official website, sales channels, newspapers and periodicals, instant messaging and other convenient means of disclosure, and provide the insured consumers of the purchased products with the necessary and reasonable reinsurance services upon expiration of the insurance period.

  此外,意见稿还强调,保险公司主动停售保险产品的,应当至少在产品停售前15日披露相关信息,因产品设计存在违法违规等问题被监管机构责令叫停的,应当于监管叫停之日起3日内披露相关信息。

In addition, the draft also stressed that if an insurance company voluntarily stops selling insurance products, it shall disclose relevant information at least 15 days prior to the suspension of the sale of the products, and if the regulatory body orders it to stop because of the existence of illegal or illegal design of the products, it shall disclose the relevant information within 3 days from the date of the suspension of the supervision.

  定价方面,意见稿要求,保险公司应当科学合理确定短期健康保险产品价格。产品定价所使用的各项精算假设应当以经验数据为基础,不得随意约定或与经营实际出现较大偏差。保险公司可以根据不同风险因素确定差异化的产品费率,并严格按照审批或者备案的产品费率销售短期个人健康保险产品。

In terms of pricing, the draft opinion requires that insurance companies should scientifically and reasonably determine the price of short-term health insurance products. The actuarial assumptions used in product pricing shall be based on empirical data and shall not be arbitrarily agreed upon or deviated from the actual operation. Insurance companies may determine differentiated product rates according to different risk factors and sell short-term personal health insurance products in strict accordance with the approved or recorded product rates.

  保额、免赔额方面,意见稿明确,保险公司应当根据医疗费用实际发生水平、理赔经验数据等因素,合理确定短期健康保险产品费率、免赔额、赔付比例和保险金额等。保险公司不得设定严重背离理赔经验数据基础的、虚高的保险金额。

In terms of the insured amount and deductible amount, the draft is clear, and the insurance company should reasonably determine the rate, deductible amount, indemnity ratio and insurance amount of the short-term health insurance products according to the actual level of medical expenses and the data of claim settlement experience. An insurance company shall not set a false and high amount of insurance which deviates from the empirical data base of claims.

  近年来,由于定价、保额、免赔额设置不合理等原因,一些险企的短期健康险出现亏损。数据显示,2018年国内4家专业互联网财险公司健康险全部出现承保亏损,承保利润合计为-亿元。随着意见稿的后续落地,短期健康险盈利情况有望出现好转。

In recent years, due to pricing, insurance coverage, deductible setting unreasonable reasons, some insurance companies short-term health insurance losses. Data show that in 2018, four domestic professional Internet property insurance companies health insurance all suffered underwriting losses, underwriting profits totaling -billion yuan. Short-term health insurance earnings are expected to improve as comments follow.

  多家险企人士对《证券日报》记者表示,一些财险公司健康险产品承保利润亏损与其对产品的定价不合理、同质化及竞争激烈导致费率设置偏低、风险管理较弱等原因有关。

A number of insurers told the securities daily that some insurance companies'health insurance product underwriting profit losses are related to their unreasonable pricing of products, homogeneity and fierce competition resulting in low rate setting and weak risk management.

  比如,一家财险公司副总裁此前对《证券日报》记者表示,公司前期对短期健康险的投入较大,包括投入大量广告费用引流等,但目前各险企之间以及保险公司与医院之间数据不能完全共享,也推高了理赔等成本。随着公司强化对大数据的应用及风险管理,健康险等其他险种有望扭亏,并实现承保盈利。

For example, a vice president of a property-insurance company previously told the securities daily that the company's previous investment in short-term health insurance, including spending on a large amount of advertising costs, has not been fully shared among insurers and between insurers and hospitals, raising the cost of claims. As the company strengthens the application of big data and risk management, health insurance and other types of insurance are expected to turn losses and achieve underwriting profits.

  华金证券研究员崔晓雁指出,短期健康险行业发展空间大并不代表竞争缓和。短期健康险产品竞争十分激烈。相较于寿险公司完备的人身健康大数据支持,主推“百万医疗保险”产品的财产险公司数据匮乏,使得其在定价方面处于劣势。此外,产品的高度同质化以及落后于寿险公司对于人身险赔付流程的管控,导致赔付金额居高不下。数据显示,人身险公司的赔付占比稳定在25%左右,而财产险公司的赔付占比已经超过75%。

Hua Jin Securities researcher Cui Xiaoyan pointed out that short-term health insurance industry development space does not represent competition detente. Short-term health insurance products are highly competitive. Compared with the complete personal health big data support of life insurance companies, the lack of data on property insurance companies that mainly push \"millions of medical insurance\" products puts them at a disadvantage in pricing. In addition, the high homogeneity of the product and behind the life insurance companies on the life insurance compensation process control, resulting in a high amount of compensation. According to the data, the proportion of compensation paid by personal insurance companies is stable at about 25%, while that of property insurance companies is already more than 75%.

  除上述重点内容外,意见稿还强化了对消费者的保护:保险公司应当以合理方式引导保险消费者完整阅读保险条款,使投保人充分了解保险产品及服务等信息;保险公司将短期健康险开发设计成主险产品的,不得强制要求保险消费者在购买主险产品的同时,必须购买该公司其他产品。

In addition to the above-mentioned key points, the draft also strengthens the protection of consumers: the insurance company should guide the insured consumers to read the insurance terms in a reasonable manner, so that the insured person can fully understand the information of the insurance products and services.


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