重疾险莫玩“白马非马”式文字游戏 | 新京报快评

Core Viewpoint - The article highlights the challenges faced by critical illness insurance, particularly regarding the complexity of contracts and difficulties in claims processing, which have led to a trust crisis in the industry [2][3]. Group 1: Issues in Critical Illness Insurance - Critical illness insurance is intended to protect families from financial risks associated with serious illnesses, but it often features complicated contracts that hinder claims [2]. - Many insurance policies appear to cover a wide range of diseases, yet the actual claims process is fraught with obstacles, leading to a perception of claims being akin to a "blind box" [2]. - The definition of critical illnesses in insurance contracts often includes restrictive conditions, resulting in frequent disputes over claims as many illnesses understood by the public are not recognized by insurers [2][3]. Group 2: Industry Response and Recommendations - The article suggests that the "single-win" mentality of some insurance companies, which focuses on profit maximization by limiting payouts, is unsustainable [3]. - To resolve these issues, the industry should adopt a "win-win" approach, prioritizing the interests of policyholders to ensure the sustainable development of critical illness insurance [3]. - Recommendations include updating disease definitions in line with medical advancements, streamlining claims processes, and shifting from restrictive practices to proactive service [3][4]. Group 3: Role of Innovation and Regulation - Insurance companies can reduce claims costs by innovating service models, such as incorporating health management services like regular check-ups and chronic disease interventions [4]. - The involvement of regulatory bodies is crucial to clarify the medical rationale behind critical illness definitions and to regulate ambiguous contract terms to prevent misleading practices [4]. - Enhancing consumer awareness and encouraging policyholders to thoroughly review contract terms and assert their rights in case of unreasonable claim denials is also essential [4].