赔付率达1412%! 上半年有险企短期健康险“赔穿”

Core Insights - The compensation rate is a critical feedback mechanism for assessing the actuarial pricing ability and risk management level of insurance companies, serving as a key decision-making basis for strategy adjustments and model optimization [1] - As of August 1, 2025, 132 insurance companies have disclosed their short-term health insurance compensation rates for the first half of the year, with over 60% reporting rates below 50%, while more than 10 companies have rates exceeding 100% [2][3] Group 1: Compensation Rate Overview - Short-term health insurance, defined as policies with a duration of one year or less without guaranteed renewal clauses, has gained popularity due to high coverage and low prices [2] - In the disclosed data, over 60% of the 132 insurance companies reported overall compensation rates for short-term health insurance not exceeding 50%, with variations in year-on-year rates [2][3] - The compensation rates for short-term health insurance vary significantly among individual companies, with the highest reaching 1412.19% and some reporting as low as 1% or even negative values [3] Group 2: Factors Influencing Compensation Rates - The high compensation rates are attributed to three main factors: rising medical inflation, inadequate product pricing, and increased adverse selection risks [3] - The "wide entry and strict exit" nature of short-term health insurance attracts individuals with pre-existing conditions, leading to potential compensation losses due to weak underwriting controls [3] - Some companies, like China Life, reported negative compensation rates due to the release of reserves for pending claims, indicating volatility in their short-term health insurance business [3] Group 3: Market Trends and Regulatory Environment - The short-term health insurance market has seen rapid growth, particularly among property insurance companies, with health insurance premium income reaching 160.9 billion yuan in the first half of the year, a 9.08% increase year-on-year [4] - Regulatory bodies have issued guidelines to ensure that insurance companies set reasonable rates and coverage limits based on actual medical costs and claims experience [5] - Future developments in short-term health insurance are expected to focus on product upgrades, risk control technology advancements, and deeper ecosystem collaboration between insurers and healthcare providers [7]