关键词 AI核保、智能服务、健康险数字化、保险科技生态、普惠保障 水滴公司于2025年以AI技术为核心驱动力，推动健康险服务实现从"人工依赖"到"智能决策"的关键转 型。其上线的AI核保专家"KEYI.AI"，依托自研"水滴水守大模型"与千万级核保知识库，实现复杂健康 险核保平均处理时间缩短80%、响应速度提升260倍、准确率达99.8%的突破，并将AI能力延伸至客服、 销售辅助、理赔协同等全流程，同时通过开放技术能力赋能行业，联合险企构建普惠生态，为保险行业 智能化转型提供实践样本。 案例正文： 在健康险市场，"投保难、核保慢"长期是用户与行业的双重痛点。调研数据显示，48%的受访者认为保 险产品"过于专业"，传统人工核保面对非结构化的医疗记录、健康问卷时，不仅平均处理周期长达数 天，还易因审核人员经验差异产生误判；带病人群、老年人群等"非标体"群体，更常因健康告知门槛陷 入"想买却难买"的困境。2025年，水滴公司通过聚焦核保环节的技术革新，将AI能力贯穿保险服务全链 条，重新定义健康险的效率与覆盖边界。 作为国内较早布局AI大模型应用的保险科技平台，水滴公司以"用互联网科技助推广大人民群众有保可 医，保 ...

Core Insights - The report highlights the growing challenge of providing insurance for individuals with pre-existing conditions in the context of an aging population and increasing chronic diseases among younger people [1][2] - The average treatment cost for this group is approximately 90,000 yuan, which is 2.1 times the annual disposable income of residents, indicating a significant financial burden [1] - The insurance industry is viewing insurance for individuals with pre-existing conditions as a key area for innovation and inclusive health insurance solutions [1][6] Group 1: Market Demand and Challenges - Nearly 30% of individuals with pre-existing conditions are denied coverage due to health disclosures, and many are unaware that they can obtain insurance despite their conditions [2][3] - Over 75% of this group desires insurance products that cover their existing conditions and are willing to pay extra premiums for such targeted coverage, indicating a substantial unmet demand in the market [2] - Medical insurance has become a necessity for 44.5% of individuals with pre-existing conditions, with specialized products for cancer recurrence and disability risks emerging as important supplements [2][3] Group 2: Differentiated Needs Among Subgroups - Older individuals with pre-existing conditions have a stronger demand for long-term stable coverage due to higher treatment costs and longer illness duration [3] - Younger individuals are more affected by sub-health and chronic diseases, preferring insurance products with lower entry barriers and flexible coverage [3] - There is a significant demand for insurance that covers pregnancy-related health issues among the mother and baby demographic [3] Group 3: Role of AI in Insurance Innovation - AI is driving systemic changes across the insurance service chain, addressing the challenges faced by individuals with pre-existing conditions [4][5] - Waterdrop Insurance has launched 214 insurance products for individuals with pre-existing conditions, with 34 being first-of-their-kind in China, and an average of 1.14 days to launch a new product [4] - AI has improved user experience and operational efficiency, with AI customer service achieving an average response time of 1.5 seconds and significantly reducing underwriting processing time [4][5] Group 4: Industry Collaboration and Ecosystem Development - Waterdrop Insurance has initiated a "Universal Product Alliance" with 18 insurance companies to scale up inclusive insurance solutions through industry collaboration [6] - The former vice-chairman of the China Insurance Regulatory Commission emphasized the need for policy, industry, and technology to work together to promote high-quality development of insurance for individuals with pre-existing conditions [6] - The insurance service chain requires enhanced collaboration among institutions to build a more robust and open insurance future, ensuring that inclusive coverage reaches all who need it [6] Group 5: Future Development Path - The development path for insurance for individuals with pre-existing conditions is becoming clearer, representing a new growth curve for the insurance industry and a commitment to inclusive and technology-driven values [7]

Core Insights - Waterdrop's AI insurance customer service "Bao Xiaohui" has been upgraded to include voice interaction, significantly enhancing user experience and operational efficiency [1][3] - The service has achieved a daily call volume exceeding 10,000, with a 40-fold increase in service capability within three months of launch, and an average response time of 1.5 seconds [1][4] Group 1: Technological Advancements - The AI Agent program architecture allows for real-time voice interaction, eliminating delays and providing a near-human conversational experience [3] - Key technological breakthroughs include seamless integration of voice recognition, intent understanding, and business processing, enabling "conversation as service" [3][4] - The system can handle high concurrency, ensuring immediate responses even during peak service times [3] Group 2: Service Efficiency - The implementation of "Bao Xiaohui" has reduced user question flow rates by over 60%, minimizing waiting times for users [4] - The AI's reasoning delay has been reduced to milliseconds, integrating complex business processes with voice dialogue capabilities [4] Group 3: Broader AI Integration - Waterdrop has developed a comprehensive AI product matrix, investing nearly 300 million yuan annually in research and development, and has applied for over 100 technology patents [5] - The AI underwriting expert "KEYI.AI" has reduced average processing time for complex health insurance underwriting by 80%, achieving a 99.8% accuracy rate [5] - AI quality inspection can cover 100% of scenarios, with costs reduced by over 50% compared to manual inspection [5]

Group 1 - The core viewpoint of the news is the recognition of Waterdrop Company as a leading private enterprise in Beijing, emphasizing its achievements in technological innovation and its inclusion in the 2025 Beijing Private Enterprises "Specialized, Refined, Unique, and Innovative" Top 100 list [1][4] - Waterdrop Company has established an "All in AI" technology development strategy, leveraging digital construction and self-developed AI models to enhance the entire insurance service process, resulting in improved efficiency and user experience [3] - The company has developed the "Waterdrop Water Guardian Model," which has received multiple patent authorizations and is expected to drive high-quality growth through enhanced service efficiency and quality [3] Group 2 - The Beijing Private Enterprises Top 100 list has been conducted annually since 2018, aiming to identify high-quality private enterprises that align with the capital's functional positioning and contribute to the high-quality development of the private economy [4] - Waterdrop Company has also been recognized for its social responsibility initiatives, marking its continuous inclusion in the Beijing Private Enterprises Top 100 as both a responsibility and an acknowledgment of its technological innovations [4] - The company aims to maintain a user-centered approach and continue investing in technology and service innovation to create greater social value in the future [4]

Core Viewpoint - Waterdrop Inc. reported strong financial performance for Q2 2025, with significant year-over-year growth in revenue and profit, driven by advancements in AI technology and innovative insurance products [1][2][3] Financial Performance - For Q2 2025, Waterdrop's net revenue reached 838 million yuan, representing a year-over-year increase of 23.9% [1] - The company's net profit attributable to shareholders was 140 million yuan, up 58.7% year-over-year, marking 14 consecutive quarters of profitability [1] - Operating expenses as a percentage of revenue decreased by 6.4 percentage points to 38.7% [1] Insurance Business Growth - Insurance-related revenue for Q2 was 739 million yuan, a 28.7% increase year-over-year, with operating profit reaching 171 million yuan, up 39% [1] - The first-year premium for insurance business grew by 80.2% year-over-year, totaling 3.204 billion yuan [1] - Short-term insurance first-year premiums increased by 95% due to enhanced customer acquisition and AI capabilities [1] - Long-term insurance first-year premiums grew by 45.4% as a result of accelerated AI model applications [1] Product Innovations - Waterdrop launched the industry's first medical insurance product that does not require health declarations and guarantees renewal for five years, targeting chronic and sub-healthy individuals [2] - The "Good Pregnancy" maternity insurance product was upgraded to version 6.0, allowing mothers with pre-existing conditions to apply [2] - The company has customized dozens of insurance products for individuals with pre-existing conditions, effectively lowering the insurance application threshold [2] Social Impact and Digital Initiatives - Waterdrop's crowdfunding platform has helped approximately 480 million users donate 70 billion yuan to 3.54 million patients since its launch [2] - The digital clinical trial business reported a net revenue of 27.7 million yuan, a 34.2% year-over-year increase, with partnerships established with 198 domestic and international pharmaceutical companies and CROs [2] AI Technology Integration - AI technology has been integrated across all business scenarios, significantly enhancing operational efficiency [2][3] - The AI medical insurance expert improved scale premium by 155% quarter-over-quarter [3] - An AI-based insurance product knowledge database was developed, containing information on approximately 7,000 insurance products, supporting real-time queries for insurance advisors [3] - The AI customer service tool "Bao Xiao Hui" provides 24/7 support, achieving 100% coverage of online service requests [3] - The launch of the industry's first AI underwriting expert "KEYI.AI" reduced the average processing time for complex health insurance underwriting by 80% and improved response speed by 260 times, with an accuracy rate of 99.8% [3]

Core Insights - Waterdrop Company has launched the first AI underwriting expert "KEYI.AI" in the insurance industry to address complexities in insurance products and improve user experience [1][2][4] - The AI system significantly reduces the average processing time for health insurance underwriting by 80% and increases response speed by 260 times, achieving a 99.8% accuracy rate in underwriting [2][3] - "KEYI" is designed to assist both insurance professionals and ordinary users, providing quick responses to inquiries and enhancing the overall insurance service experience [3][4] Group 1 - 48% of respondents find insurance products overly complex, leading to decision-making difficulties [1] - Traditional underwriting processes are slow and fragmented, negatively impacting user experience [1] - "KEYI.AI" enables 24/7 user service with instant responses and precise replies [1][2] Group 2 - The AI underwriting system helps insurance companies quickly identify clients who do not meet health criteria, reducing the risk of adverse selection [2] - "KEYI" covers thousands of insurance product terms and utilizes a vast database for risk assessment and claims processing [2][3] - The system can be integrated within three days, enhancing onboarding speed for new insurance agents by 300% [3] Group 3 - Waterdrop invests nearly 300 million yuan annually in R&D and holds over 100 technology patents [4] - The company has developed multiple AI products, including AI agents and intelligent customer service solutions, to improve service efficiency [4] - The founder emphasizes that the future competition in the industry will focus on algorithm precision and data quality rather than just manpower and capital [4]

Core Insights - The introduction of "KEYI.AI" by the company aims to simplify the insurance underwriting process, addressing user difficulties due to complex insurance terms and slow traditional processes [1][2][4] - "KEYI.AI" significantly reduces the average processing time for health insurance underwriting by 80% and increases response speed by 260 times, achieving a 99.8% accuracy rate in underwriting [2][3] Group 1: AI Underwriting Innovation - "KEYI.AI" utilizes a vast knowledge base and advanced AI capabilities to enhance the underwriting process, allowing for rapid risk assessment and personalized insurance solutions [2][4] - The system's implementation leads to a sixfold increase in the proportion of rejected clients finding suitable insurance products [1][2] Group 2: User Experience Enhancement - The AI system provides 24/7 user service with instant responses, improving overall user experience in the insurance sector [1][3] - The average time to resolve user inquiries is reduced to 50 seconds, significantly enhancing the onboarding speed for new insurance agents by 300% [3] Group 3: Strategic Vision and Investment - The company has invested nearly 300 million annually in AI research and development, holding over 100 technology patents, positioning itself as a leader in AI applications within the insurance industry [4][5] - The CEO emphasizes that the future competition in the industry will focus on algorithm precision and data quality rather than just manpower and capital [5]

Core Insights - The 2025 China Internet Conference focused on the transformation of internet technology and its application in driving high-quality development, featuring over 30 thematic activities aimed at integrating internet technology with the real economy [1] - Waterdrop Inc. showcased its AI-driven insurance applications at the conference, emphasizing the creation of a diversified health protection ecosystem and efficiency improvements [1] Group 1: AI Innovations - Waterdrop's AI Agent has advanced capabilities in multi-modal interactions, significantly enhancing efficiency in sales support services, capable of handling consultations for various insurance types with a maximum single voice interaction duration of 50 minutes and an average response time of around 2 seconds [2] - The AI Agent can provide clear and logical responses to user inquiries about insurance terms and claims, moving beyond rote answers to logical reasoning, thus improving user engagement and satisfaction [4] Group 2: Cost Efficiency and Quality Control - Waterdrop's AI quality inspection solution achieves 100% coverage across all scenarios, including voice and chat records, while reducing quality inspection costs by over 50% compared to manual processes [5] - The introduction of the AI customer service agent "Bao Xiaohui" is expected to reduce question transfer rates by 50% and improve service efficiency by 50%, providing timely responses 24/7 [4][5] Group 3: Financial Performance and Strategic Direction - Waterdrop invests nearly 300 million yuan annually in technology research and development, holding over 100 technology patents, and anticipates a nearly 120% growth in net profit attributable to the parent company in 2024 [5] - The company is committed to an "All in AI" strategy for 2025, aiming for a new growth trajectory through the integration of AI across all business operations [5]

Core Insights - Waterdrop's business innovation case has been recognized by Harvard Business School, highlighting its AI-driven approach in the insurance and healthcare sectors [1][5] - The company has implemented a comprehensive "All in AI" strategy, significantly enhancing its operational efficiency and service delivery [2][4] Group 1: Recognition and Impact - Waterdrop's case study is included in Harvard Business School's case library, which represents the highest standard of international teaching cases [1] - The case explores how Waterdrop leverages AI technology for systematic innovation and strategic upgrades, contributing to a diversified health protection ecosystem [1][5] Group 2: Business Model and Technology Investment - Waterdrop invests nearly 300 million yuan annually in technology research and development, resulting in over 100 technology patents and a comprehensive application system covering all insurance scenarios [2] - The company operates multiple business lines, including Waterdrop Fundraising, Waterdrop Insurance, Yifan Medicine, Waterdrop Finance, and Luhong Wuyou, creating a multi-faceted service ecosystem [2] Group 3: AI Integration and Performance - In 2024, Waterdrop's net profit attributable to shareholders increased by nearly 120% due to the empowerment of AI large models [4] - The self-developed model "Waterdrop AI Insurance Expert" is applied across the entire insurance health service process, enhancing sales assistance and operational efficiency [4] Group 4: Customer Service Innovations - Waterdrop has launched "AI Customer Service" named "Bao Xiaohui," which can accurately identify user emotions and respond promptly, potentially reducing issue transfer rates by 50% [4] - The AI quality inspection solution has been implemented, covering various communication channels and significantly reducing the costs associated with manual quality checks [4]