2025年度保险理赔报告密集出炉：“直付”服务打通壁垒，重疾出险年轻化、仍存较大保障缺口

Core Insights - The insurance industry is witnessing a significant shift in claims and service models, with a focus on digitalization and direct payment services, enhancing the efficiency of claims processing [1][8] - Total claims paid by life insurance companies reached 1.18 trillion yuan, while property insurance companies paid 1.03 trillion yuan in 2025, both showing an increase compared to the previous year [1] - Medical insurance remains the dominant category in terms of claim numbers, while critical illness insurance accounts for a significant portion of claim amounts, highlighting a growing awareness of health risks among residents [5][6] Group 1: Claims Data Overview - Major insurance companies reported substantial increases in claims for 2025, with China Life processing over 62.24 million claims, a 7% increase year-on-year, and total claims amounting to over 100.4 billion yuan, a 10% increase [2] - China Pacific Life reported 4.24 million claims with a total payout of 20.1 billion yuan, while Ping An Life processed 4.96 million claims totaling 41.51 billion yuan [3] - China Property & Casualty Insurance processed over 200 million claims, with a total payout exceeding 380 billion yuan, marking a growth of over 10% [2] Group 2: Critical Illness and Medical Insurance Trends - Medical insurance claims accounted for over 90% of total claims in many companies, while critical illness insurance represented over 50% of the total payout amounts [5][6] - The trend of younger individuals being diagnosed with critical illnesses is rising, with significant claims from the 40-60 age group, and the 18-40 age group showing a high incidence rate [6][7] - Despite the increase in awareness and claims, the average payout for critical illness insurance remains insufficient to cover the high costs of treatment, with many claims below 100,000 yuan [7] Group 3: Digitalization and Service Improvements - The introduction of direct payment services has streamlined the claims process, allowing patients to avoid upfront costs, with China Life reporting 8.17 million direct payment claims totaling over 4.3 billion yuan [8][9] - The digital transformation in the insurance sector has led to over 90% of claims being processed online for several companies, significantly improving efficiency [8][9] - Companies are leveraging technology, including IoT and automated claims processing, to enhance service delivery and customer experience [9]