数字化理赔

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上半年多家险企获赔率超99% “秒赔”与“直付”成新常态
Jin Rong Shi Bao· 2025-07-24 01:18
Core Insights - The insurance industry is experiencing a significant increase in claim payouts and service efficiency, with digital and intelligent claims processing becoming standard practice [1][2][4] Group 1: Claim Performance - Major insurance companies reported substantial claim volumes in the first half of 2025, with China Life Insurance processing over 12.14 million claims totaling over 30.2 billion yuan, and Ping An Life handling 2.377 million claims amounting to 20.62 billion yuan [2] - The industry maintains a high claim approval rate, with several companies exceeding 99%, including China Life and Citic Prudential, which both achieved 99.6% [2] - Critical illness insurance accounted for a significant portion of claims, with China Pacific Insurance reporting 5.23 billion yuan in critical illness claims, representing 52.7% of their total payouts [2] Group 2: Medical Insurance Trends - Medical insurance claims are the most frequent, with Ping An Life reporting that 92% of their claims were for medical insurance, while Sunshine Insurance reported 83.7% [3] - The prevalence of medical claims highlights the close connection between insurance products and public health needs [3] Group 3: Technological Advancements - Insurance companies are leveraging technology to enhance claims efficiency, with Ping An Life achieving 93% of automated claims processed within 60 seconds using their DeepSeek model [4][5] - China Life's claims processing time has improved significantly, with small medical claims being settled in an average of 0.37 days [4] Group 4: Direct Payment Services - The industry is focusing on "direct payment" services, allowing for seamless integration between hospitals, health insurance, and commercial insurance, enabling patients to settle claims upon discharge [6][7] - China Life has pioneered direct payment initiatives, processing over 3.91 million direct payment claims worth over 2.13 billion yuan in the first half of 2025 [7] - Other companies, such as Ping An Life and Taikang Life, have also introduced similar direct payment services, enhancing customer convenience [7]