21 Interpretation ｜ The China Banking Regulatory Commission investigates the short -term health insurance business notification to criticize the "drug fee transfer premiums" model

Southern Finance All Media Zheng Jiayi Beijing Reporting Beijing

On August 9, the 21st Century Business Herald reported that the Property and Insurance Regulatory Department of the Banking Insurance Regulatory Commission issued a recent "Notice on the Existing problems and related risks in the short -term health insurance business in some property insurance companies" (hereinafter referred to as the "Notification"). Some insurance companies in the short -term health insurance business of some insurance companies notified criticism, and required various property insurance companies to check the short -term health insurance business in time to ensure that the business is compliant in accordance with the law, ensuring the sustainability of the business, maintaining the industry's good industry. Social image.

It is reported that the industry rectification of this short -term health insurance originated from the CBRC's Property Insurance Department in the process of carrying out daily supervision and non -on -site monitoring. "Drug fee transfer premium" model.

What is "drug fee transfer premium"?

Industry insiders pointed out that during the transformation of non -auto insurance business in property insurance companies, the choice of “risking” under pressure such as premium growth, market scale, and performance needs.

Such products often cooperate with insurance companies and intermediary agencies to reduce the compensation period, cancel the waiting period, and set the premium income to drug prices to set similarly to the "premiums" through short -term health insurance products. In essence, it does not bring profit growth, but it can "decorate the facade" through the rapid growth of premiums.

In the "Notice", the Bank of Insurance Regulatory Commission's Property Insurance Department pointed out that many insurance companies' short -term health insurance business has grown rapidly, and it is basically concentrated in the same type of business model.

In this model, the corresponding insurance company and related business clusters with Internet hospitals, health technology companies, and insurance brokerage companies have cooperated in the process of cooperation in related business clusters. Essence And in the actual business underwriting, the company can meet the needs of the business model by setting the waiting period to 0 days, setting the insurance liability termination condition to pay at one time, and the premium income is similar to the price of drugs. And the company has not participated in the core risk management link, and the business continues to lose money.

In the short term, such models may be beneficial to the performance income for a moment, but essentially violated the principles of large insurance rules and principles of shooting, and cannot bring stable and continuous premium increases to insurance companies, and even make the corresponding company business continued Lost.

Deputy Secretary -General of the China Institute of Insurance, Beijing University of Technology, said that such phenomena reflect the excessive importance to the scale of premiums and market growth during the transformation of non -auto insurance business. Under the pressure The design of the product design, seeking "virtual high" premiums, is not conducive to the long -term and healthy development of insurance companies. "Strategic purchase of strategic purchases with the advantages of the health insurance market size of insurance companies is one of the direction of future business development, but the prerequisite is that insurance companies must master core costs and negotiation capabilities. The current short -term group purchase operation insurance company has not participated in core risks In the management and control link, the business continues to lose money. From the perspective of guiding the industry's long -term healthy development, supervision controls this business model. "

He Xiaowei, director of the Insurance College of the University of Foreign Economics and Trade, said that the principle and functions of such products from the principles and functions of insurance can hardly play a role of risk sharing. "On the surface, such products are equivalent to insurance companies participating in large health -related industries and entering the industrial chain to complete closed -loop payment; in fact, insurance companies do not have the role of poverty alleviation. The advantage is that insurance companies can enter the health care industry chain and obtain more. Cooperation opportunities, potential customer acquisition; risk is that insurance companies are just paymenters, why do not grasp why pay and pay. This model may bring financial loopholes, and risk exposure is even greater. "

Short -term health insurance needs to return to "guarantee the origin"

In recent years, with the deepening of the comprehensive reform of the auto insurance and the rapid development of non -car insurance business, coupled with the flexible characteristics of its low rate, high insurance amount, and high leverage, short -term health insurance is extremely popular in a short time, becoming a recommendation page for major social platforms. The "frequent visitor". Data show that in the first half of 2022, the short -term health insurance premium income of property insurance companies reached 115.6 billion yuan, an increase of 15.4%year -on -year.

At the same time as the rapid growth of premiums, the healthy development of short -term health insurance has also aroused market and regulatory attention.

According to the CBRC's disclosure, there were large tickets issued over 800,000 yuan in issues such as head insurance institutions due to short -term health insurance product rates exceeding 30%of the benchmark rate, and changing insurance liability through approval orders. In January 2021, the China Banking Regulatory Commission also issued the "Notice on Regulating the Problems Related to the short -term health insurance business", during the insurance period of short -term health insurance, insurance liability, liability exemption, claims conditions, surrender agreed, premium payment methods, waiting periods Settings, insurance amounts, deductibles, compensation ratio and other products such as the design and expressions of the product's key information are required.

In this "Notice", the Bank of Insurance Regulatory Commission's financial and insurance department stated that there are two main problems and risks in the above -mentioned "drug fee transfer premiums" business.

First, the insurance company underwritten is the medical expenses that have been determined. It does not meet the basic insurance principles such as the large number of laws and the principle of shooting, and cannot pass major risk testing. Second, the risk management and control of insurance companies is lacking. The core links such as front -end underwriting and back -end claims are controlled by relevant institutions. The insurance company does not master the autonomous pricing power and does not substantially participate in risk management. It cannot reflect the basic function of insurance operation management risks. According to the financial insurance department of the Banking Insurance Regulatory Commission, such short -term health insurance products actually undertake medical expenses expenditure expenditure with frequency determination and loss of losses, alienated insurance business, making insurance or incidents an inevitable event.

He Xiaowei pointed out that the biggest challenge of the health insurance business of insurance companies is risk control. "Whether it is in the long run, short -term, health insurance needs to face risk control, not just as a cashier. How to pay? How much to pay? There are many factors that involve the insurance company. Instead, finding 'shortcuts' will only take more controlling factors in turn. For example, the above -mentioned companies have carried out the "innovation' that deviates from the origin of insurance, and the final performance continues to lose money."

The "Notice" pointed out that in the future, the Bank of Insurance Regulatory Commission's property and insurance department will take supervision measures on relevant companies with relevant CBRC. Each property insurance company shall timely investigate the short -term health insurance business, and shall not carry out any similar or not in the insurance. Principles, loss of insurance or short -term health insurance business, ensure that the business is compliant in accordance with laws and regulations, and ensure the sustainability of the business. It will be submitted to the Financial and Insurance Department of the Banking Regulatory Commission and the Land Banking Regulatory Bureau before August 19. All Banking and Insurance Regulatory Bureau should continue to pay attention to such business situations, strengthen risk monitoring and supervision and inspection, and take relevant regulatory measures or administrative penalties to the problems found in a timely manner.

At the same time, the Banking and Insurance Department of the CBRC stated that in the next step, various property insurance companies should closely carry out product innovation work around the insurance guarantee, combined with the risk characteristics of different insureds, continue to optimize insurance products, reflect risk security responsibilities, and meet different people in different people. The needs of drugs and health management services will carry out short -term health insurance business in accordance with laws and regulations.

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