Core Insights - The core message of the report is that Zhonghong Insurance has significantly improved its claims service through digital empowerment and process optimization, aiming to enhance customer satisfaction and service experience in 2025 [1] Claims Performance - In 2025, Zhonghong Insurance processed a total of 176,000 individual and group insurance claims, with total payouts reaching 880 million yuan [1] - Since its establishment in 1996, the company has handled a cumulative total of 2.946 million claims, with total payouts amounting to 7.1 billion yuan [1] - Individual insurance claims in 2025 amounted to 770 million yuan, representing a year-on-year increase of 19.3%, with 62,516 claims processed [1] - The average claim settlement time was only 0.19 days, with the fastest claim payment completed in just 1 minute [1] - Online claims usage reached a new high of 97.2%, an increase of 5.6% from the previous year, indicating successful digital transformation efforts [1] Medical Claims Insights - Medical claims accounted for over 90% of total claims, with 47,859 medical claims processed in 2025, totaling approximately 116 million yuan [2] - The leading cause of medical claims across all age groups was "accidental injuries," with specific health issues varying by age group [2] - Critical illness claims represented over 60% of total payout amounts, with payouts of approximately 468 million yuan in 2025, and an average payout exceeding 180,000 yuan per claim [2] Demographic Analysis - Female claimants had a significantly higher volume of critical illness claims compared to males, particularly in breast cancer and cervical cancer cases, while males faced more digestive system diseases [3] - The majority of critical illness claims were concentrated in the 41-60 age group, followed by the 18-40 age group [3] Service Quality and Customer Feedback - The net promoter score for claims service remained high in 2025, with 87% of respondents rating their claims experience 9-10 out of 10 due to the speed of claims processing [4] - 39% of respondents rated the simplicity of the claims process 9-10 out of 10, an increase of 18% from 2024 [4] - The company has completed over 2.946 million claims over its 30-year history, maintaining a commitment to customer-centric service [4]

Core Viewpoint - The commercial health insurance sector is currently in a phase of "selecting from a menu," with significant potential for innovation as the market approaches a trillion yuan scale. The year 2025 is anticipated to be a pivotal year for commercial health insurance, marked by the release of an innovative drug directory and regulatory encouragement for the development of insurance products for individuals with pre-existing conditions [1] Group 1: Commercial Health Insurance Development - The 2025 National Medical Security Work Conference emphasized the support for the development of commercial health insurance, placing it as a priority in establishing a multi-tiered medical security system [1] - The conference called for the integration of commercial health insurance with basic medical insurance, encouraging the inclusion of reasonable medical expenses outside the basic insurance directory and promoting investment in innovative drugs [1][3] - The market is expected to shift from a focus on rapid growth to a more structured approach that addresses the diverse needs of the elderly and individuals with pre-existing conditions [1] Group 2: Innovative Drug Directory - The first version of the commercial health insurance innovative drug directory includes only 19 types of drugs, primarily for specific clinical uses with clear reimbursement rules [4] - Concerns remain regarding the implementation of this directory, particularly whether the listed drugs can be easily accessed in hospitals and whether negotiated discount prices can translate into higher reimbursement rates [5][6] - The directory aims to facilitate the entry of high-value innovative drugs into public hospitals, enhancing the synergy between commercial health insurance and basic medical insurance [3][5] Group 3: Role of Commercial Health Insurance in Clinical Pathways - There is an expectation for commercial health insurance to play a more active role in optimizing clinical pathways for patients, moving from a passive reimbursement model to influencing treatment decisions [7] - The integration of innovative drugs into the insurance payment framework is seen as a way to enhance the insurance sector's influence on healthcare practices [7][10] - The need for collaboration with healthcare providers and access to clinical data is crucial for commercial insurers to effectively manage costs and improve patient outcomes [10][11] Group 4: Market Innovations and Trends - The aging population is driving demand for innovative health insurance products, with a focus on integrating group and individual health insurance models [12][13] - The concept of "personal account-based long-term medical insurance" is emerging, which combines long-term medical coverage with savings features, potentially addressing the challenges posed by an aging society [13][15] - Employers can benefit from this innovative model by attracting and retaining employees while facilitating their long-term health savings [14][15]

Core Insights - The global insurance industry is entering a phase of slowed growth and profit pressure, moving away from a decade driven by scale [6][8] - External factors such as economic fluctuations and geopolitical tensions continue to impact traditional profit models, while climate change poses significant risks to property insurers [6][8] - The competitive landscape is shifting from a focus on licensing and scale to one centered around technology, capital, and service capabilities [8][35] Non-Life Insurance Sector - The non-life insurance sector is facing a new pressure phase after exiting a difficult underwriting cycle, with global premium growth expected to slow down [10] - The underwriting cost ratio in the U.S. is projected to rise from 97.2% in 2024 to 99% in 2026, further compressing profit margins [10] - Factors driving cost increases include tariffs, supply chain disruptions, labor shortages, and rising material prices, particularly affecting auto and property insurance [10][11] - Legal risks are increasing complexity in non-life insurance, with rising litigation financing leading to higher claims rates and severity [10] Life and Annuity Insurance - Life insurance premium growth is slowing in developed markets, while annuity sales in the U.S. are expected to reach $432.4 billion in 2024, continuing strong growth [13] - The asset management size in the insurance industry is projected to grow by 25% to $4.5 trillion by 2024, with personal credit becoming a larger share [14] - The integration of private equity into the insurance sector is accelerating, reflecting dual pressures on both asset and liability sides [15][16] Group Insurance Sector - The group insurance sector is evolving towards a tighter integration of employee benefits and insurance services, with new growth areas emerging [20] - The B2B2C model in group insurance emphasizes the importance of user experience for both employers and employees [21] - Digital access capabilities are becoming critical in group insurance competition, with companies needing to integrate products into employer benefit platforms [23] AI and Technology Integration - The report highlights that the main barrier to scaling AI in the insurance industry is not the algorithms but rather data quality and system infrastructure [26][29] - Successful AI applications are being implemented across various functions, such as underwriting and claims processing, enhancing efficiency and service delivery [30] - The future insurance workforce will need to focus on complex problem-solving and customer engagement rather than routine tasks [30] Customer Experience Transformation - Customer expectations are shifting towards speed, convenience, and personalization, necessitating a move from "omni-channel" to "channel adaptation" [33] - Insurers must provide seamless service experiences, with simple requests directed to self-service channels and complex inquiries handled by experienced professionals [33] - The overall competitive structure of the insurance industry is being redefined, with technology, capital flexibility, and customer-centric service systems becoming key competitive factors [35]

Core Insights - The global insurance industry is entering a phase of slowing growth and profit pressure, moving away from a decade driven by scale [1] - The competitive paradigm is shifting from reliance on licenses and channels to a focus on technology, capital, and service capabilities [2] Non-Life Insurance Sector - The non-life insurance sector is experiencing a "tech war" focused on technology and cost evolution, with global premium growth expected to slow down [3] - The underwriting cost ratio in the U.S. is projected to rise from 97.2% in 2024 to 99% in 2026, further compressing profit margins [3] - Factors driving cost increases include tariffs, supply chain disruptions, labor shortages, and rising material prices, particularly affecting auto and property insurance [3] - Legal risks are increasing complexity in non-life insurance, with third-party litigation financing spreading to various markets, raising claims rates and severity [3][4] Life Insurance and Annuities - Life insurance premium growth is slowing in developed markets, while annuity sales in the U.S. are expected to reach $432.4 billion in 2024, with strong growth continuing into 2025 [6] - The insurance industry's managed asset scale is projected to grow by 25% to $4.5 trillion by 2024, with personal credit's share increasing to 21.1% [7] - The integration of private equity into life insurance reflects dual pressures on both asset and liability sides [8] Group Insurance Sector - The group insurance sector is evolving towards a "B2B2C" experience, with new growth in niche areas like workplace childcare support and gig economy insurance [13] - The competitive edge in group insurance is increasingly determined by the ability to provide an exceptional end-user experience [14] Technology and AI Integration - Technology is becoming crucial for enhancing actuarial capabilities and controlling claims costs, with applications like generative AI and IoT being implemented [5] - AI is being used to automate underwriting and claims processes, significantly improving efficiency without expanding workforce [17][19] - The insurance industry faces a talent shortage in professionals who understand both insurance and data science, necessitating a strategic transformation in talent management [21] Customer Experience and Service Transformation - Customer expectations are shifting towards seamless service characterized by speed, convenience, and personalization [22] - The transition from "omni-channel" to "channel adaptation" reflects a need for intelligent guidance based on customer intent and business complexity [22] - Companies like Cigna are linking employee compensation to service metrics to enhance service culture, supported by technology [22] Structural Changes in the Insurance Industry - The long-standing reliance on scale, products, and channels is being replaced by new competitive structures focused on technology, capital flexibility, and customer value [24] - The insurance industry is facing a structural transformation that will redefine competition over the next decade, with leading firms likely to integrate technology development, customer experience design, and platform ecosystem capabilities [24]

Introduction - The report by Deloitte analyzes the major trends, challenges, and opportunities facing the global insurance industry by 2026, highlighting the impact of economic volatility, geopolitical instability, and natural disasters on the market [1][29]. Property and Casualty Insurance (P&C) - The global premium growth in P&C insurance is expected to slow down due to intensified market competition and weakened rate growth, with emerging markets particularly affected by economic slowdowns [2][32]. - Advanced technologies like AI and geospatial analysis are aiding insurers in accurately predicting and minimizing losses across various insurance types [3][37]. - Insurers are encouraged to adopt agile capital strategies, utilizing third-party reinsurance and catastrophe bonds to enhance capital flexibility [4][36]. Life and Annuity Insurance (L&A) - Global life insurance growth is slowing, particularly in developed markets, while emerging markets present growth opportunities due to expanding middle-market segments [5][38]. - Annuity products are experiencing strong growth, with sales expected to reach $432.4 billion in 2024, driven by innovative product offerings and strategic alliances with alternative asset management firms [6][40]. - Insurers are forming partnerships to diversify revenue streams and enhance traditional product offerings, particularly in non-traditional service areas [6][43]. Group Insurance - Group insurance growth is projected to slow due to tightening labor markets and rising healthcare costs, impacting traditional employer-sponsored benefit plans [7][47]. - Insurers are introducing innovative products that integrate annuities into retirement benefit plans to meet diverse workforce needs [8][49]. - Digital interaction capabilities are essential for insurers to provide seamless service experiences and connect effectively with employer platforms [9][50]. AI Success Factors - Insurers must focus on data quality, system modernization, and security to successfully implement AI applications [10][53]. - Modernizing legacy systems and establishing robust data management practices are critical for integrating AI into business operations [11][55]. - A strong emphasis on cybersecurity and the selection of reliable third-party vendors is necessary to maintain customer trust and protect sensitive data [12][59]. Human-Machine Collaboration - Successful digital transformation in the insurance industry hinges on effective human-machine collaboration, requiring a reevaluation of employee skills and the creation of a modern employee value proposition [13][61]. - Companies need to attract and retain talent capable of adapting to evolving roles and leveraging AI tools effectively [14][63]. Enhancing Customer Experience - A customer-centric approach that integrates digital and human service touchpoints is vital for delivering empathetic and seamless service experiences [15][20]. - Insurers should adapt service channels based on customer intent and behavior to improve satisfaction and reduce service costs [16][20]. Policy Implications - The "One Big Beautiful Bill Act" introduces tax incentives and regulatory uncertainties that insurers must navigate to ensure compliance and capitalize on potential benefits [17][18]. - Insurers need to establish data collection processes to meet compliance requirements related to tax modeling and reporting [18][18]. Strategic Collaboration - Building strategic networks with technology providers and reinsurers is essential for sharing risks and developing innovative products and services [19][19]. - Insurers should prioritize customer needs and integrate digital and human service channels to enhance overall service delivery [20][20]. Digital Foundation - Investment in data quality and core system modernization is crucial for scaling AI applications and fostering a culture of innovation within the industry [21][21].

Core Viewpoint - The article discusses the recent establishment of a commercial health insurance (CHI) innovative drug directory in China, marking a significant shift towards a dual-track payment system for innovative drugs, alongside the traditional national medical insurance system [4][6][12]. Group 1: Introduction of Commercial Health Insurance Innovative Drug Directory - The CHI innovative drug directory focuses on high-innovation, clinically valuable drugs that cannot be included in the basic medical insurance directory due to their high costs [4][6]. - This directory aims to address the multi-layered payment challenges for innovative drugs, with the implementation of supportive measures still pending [4][6]. Group 2: Transition to Dual-Track Payment System - The introduction of the CHI innovative drug directory represents a historic transition from a single-track medical insurance system to a dual-track system combining both national medical insurance and commercial health insurance [6][12]. - The new policy is expected to alleviate the financial pressure on the basic medical insurance fund while enhancing access to innovative drugs [6][12]. Group 3: Current Challenges in Commercial Health Insurance - There are significant disparities in coverage provided by commercial health insurance for innovative drugs, with only 7.7% of the market being covered by CHI [7]. - The current commercial health insurance market is small, and expanding its scale is a pressing issue, with group insurance being a potential avenue for growth [12][13]. Group 4: Implementation and Operational Challenges - The successful implementation of the CHI innovative drug directory requires collaboration among the National Medical Insurance Administration, pharmaceutical companies, and insurance providers [10]. - There are concerns regarding the ability of existing commercial health insurance products, such as "Hui Min Bao," to adequately cover innovative drugs due to low reimbursement rates [11][12]. Group 5: Need for Improved Payment Mechanisms - The article emphasizes the need for improved payment mechanisms, such as direct settlement systems, to facilitate the integration of innovative drugs into hospitals [16]. - Establishing a collaborative mechanism between medical insurance and commercial health insurance is crucial for effective implementation and data sharing [16].

Core Insights - The insurance industry is experiencing a price war driven by new entrants competing for market share, leading to a paradox where increasing premium rates results in poor sales, while maintaining low rates limits coverage expansion [1][4]. Group 1: Market Dynamics - The trend of high-end medical insurance products being downgraded to mid-range options reflects a shift in focus among insurers, with many companies now offering mid-tier products that closely resemble their high-end counterparts in terms of coverage [3]. - The competition in the "pre-existing conditions" insurance market is intensifying, with many insurers expanding their product offerings to include more comprehensive coverage while struggling to balance premium growth with coverage responsibilities [2][6]. Group 2: Pricing Strategies - Insurers are facing challenges in maintaining premium rates due to increased competition, which is forcing them to innovate in areas such as actuarial science and service delivery to remain competitive [5]. - The introduction of low-premium, no-health-disclosure products indicates a shift towards more accessible insurance options, although this raises concerns about the sustainability of such pricing models [4][7]. Group 3: Risk Management - Despite the expansion of coverage responsibilities outpacing premium growth, the perceived operational risks for insurers are not as high as the public might believe, thanks to improved data analytics and risk assessment capabilities [6][7]. - The integration of healthcare data and advancements in insurance technology, particularly AI, are enabling insurers to better evaluate risks and adjust pricing dynamically, which is crucial for managing the balance between affordability and coverage [7][8]. Group 4: Future Considerations - The industry faces ongoing challenges in addressing the diverse needs of consumers with pre-existing conditions, necessitating further exploration of differentiated pricing strategies to avoid a one-size-fits-all approach [8].

Core Viewpoint - The Chinese commercial health insurance market is showing signs of recovery after three years of slow growth, with expectations to surpass 1 trillion yuan this year. However, a structural transformation is urgently needed, shifting from "insuring healthy people" to "insuring people's health" [1][4]. Group 1: Market Dynamics - The "sick body" insurance market, which covers individuals with pre-existing conditions or chronic diseases, is crucial for building a multi-tiered medical security system and promoting innovative drug development [1][4]. - In August, Shanghai introduced measures to encourage insurance companies to include elderly individuals and those with pre-existing conditions in their coverage, aiming for high-quality development of commercial health insurance [1][3]. - The group insurance market, while larger in absolute scale, has been facing challenges such as increased claims ratios and slowing growth rates due to rising medical costs and competitive pressures [3][6]. Group 2: Financial Contributions - In 2024, individual health insurance products like "Hui Min Bao" and "Million Medical Insurance" contributed nearly 40% of the commercial insurance payments for innovative drugs, totaling approximately 4.5 billion yuan, while group insurance contributed less than 10%, around 1 billion yuan [3][5]. - The annual premium scale of group insurance has exceeded 100 billion yuan, accounting for nearly 30% of the commercial health insurance market [4][5]. Group 3: Challenges and Opportunities - The group insurance market is experiencing a "survival" focus rather than "responsibility expansion," with claims ratios reaching 70%-80% due to the nature of the products [3][6]. - The market is facing a "two-eighty rule," where 20% of large corporate clients pay 80% of the premiums, indicating a concentration of demand among healthier, higher-paying employees [5][6]. - There is a growing recognition that reform in group insurance is necessary to accommodate innovative drug coverage, as current products are primarily designed for small, frequent claims [8][9]. Group 4: Future Outlook - The shift towards group insurance as a more stable option for medical coverage is seen as more feasible than relying on individual payments, especially in the context of rising healthcare costs and economic pressures on companies [10].

Group 1 - The core viewpoint of the article is that after three years of slowdown, the Chinese commercial health insurance market is showing signs of recovery and is expected to surpass the trillion yuan mark this year, but structural transformation is urgently needed from "insuring healthy people" to "insuring people's health" [2][3] - The development of insurance for the "sick population" is crucial for building a multi-tiered medical security system and for the growth of innovative drugs [3] - Shanghai has taken the lead in promoting high-quality development of commercial health insurance with measures that encourage insurance institutions to include elderly individuals and those with pre-existing conditions in their coverage [3] Group 2 - In 2024, individual health insurance products like "Hui Min Bao" and "Million Medical Insurance" contributed nearly 40% of commercial insurance payments for innovative drugs, totaling approximately 4.5 billion yuan, while group insurance accounted for less than 10%, around 1 billion yuan [5][7] - The group insurance market, while larger in absolute scale, has been facing challenges such as a focus on common illnesses rather than major illness reimbursements, leading to a high claims ratio of 70%-80% [5][6] - The annual premium scale of group insurance has exceeded 100 billion yuan, accounting for nearly 30% of the commercial medical insurance market [6] Group 3 - The contribution of group insurance to innovative drug payments is limited, with a significant gap in coverage for special drugs, which are typically high-cost and effective treatments for severe diseases [7] - The group insurance market is characterized by a "20-80 rule," where 20% of large corporate clients pay 80% of the premiums, indicating a strong demand for high-value drugs among these clients [7][9] - The average claims ratio for group insurance is expected to remain high, around 80%, due to rising medical costs and increased health awareness among employees [9] Group 4 - Reform of group insurance is necessary to incorporate innovative drug coverage, as the current model leads to overuse of small medical claims and insufficient protection for major illnesses [10][11] - The commercial health insurance market is entering a phase where individual purchasing power is limited, making it more feasible to upgrade medical coverage based on group insurance rather than relying on individual payments [11]

Core Viewpoint - The Chinese commercial health insurance market is showing signs of recovery after three years of slowdown, with expectations to surpass a trillion yuan in scale this year. However, a structural transformation is necessary, shifting from "insuring healthy people" to "insuring people's health" [3]. Group 1: Market Dynamics - The development of insurance for individuals with pre-existing conditions or chronic diseases, referred to as "sick population," is crucial for building a multi-tiered medical security system and promoting innovative drug development [3]. - In 2024, individual insurance products like "Hui Min Bao" and "Million Medical Insurance" contributed nearly 40% of commercial insurance payments for innovative drugs, totaling approximately 4.5 billion yuan, while group insurance contributed less than 10%, around 1 billion yuan [5][8]. - The group insurance market, despite its larger absolute scale, is primarily focused on common illnesses rather than major illnesses, with a payout ratio typically between 70% and 80% [5][6]. Group 2: Policy Support and Innovation - Shanghai's "New 18 Measures" encourages insurance institutions to include elderly individuals and those with pre-existing conditions in their coverage, aiming to foster high-quality development of commercial health insurance [3][6]. - The group insurance market is facing challenges such as slowing growth rates and rising payout ratios, necessitating innovative product development to support the payment for innovative drugs [6][9]. Group 3: Challenges in Group Insurance - The group insurance market is experiencing a "two-eight rule," where 20% of large corporate clients account for 80% of the premiums, indicating a concentration of health-conscious and financially capable clients [9]. - Due to economic pressures, many small and medium-sized enterprises are reducing their group insurance budgets, impacting the overall market dynamics [9][10]. - The average payout ratio for group insurance is expected to remain high, around 80%, due to increased medical expenses and a rise in the number of employees with chronic conditions [11][12]. Group 4: Future Directions - Reform of group insurance is essential to accommodate the coverage of innovative drugs, as the current model may lead to overuse of small medical expenses and insufficient coverage for major illnesses [13][14]. - The shift towards upgrading medical insurance based on group insurance fundamentals is seen as a more feasible approach compared to direct individual payments, especially in a challenging economic environment [14].