China Life Insurance critical illness insurance Health Instructions

New insurance law on serious illness insurance

Sign the insurance reminder before applying for insurance.

According to the relevant requirements of China Banking and Insurance Regulatory Commission, all life insurance companies must clearly remind the precautions and risks of insurance by using the Personal Insurance Insurance Insurance Tips. On the one hand, it is to fulfill the obligation of informing and protect consumers' rights and interests, on the other hand, it is also for insurance companies to take this as evidence from the perspective of protecting themselves, and strive to avoid the negative impact of disputes caused by vague propaganda. Accordingly, all personnel in the life insurance exhibition industry need to show insurance tips when selling designated products, and banks (information forum products) also need to provide insurance tips, otherwise it will be illegal. Before signing the insurance application, the insured should read this reminder carefully and sign it in person. Personal insurance (information forum product) tips mainly include insurance risks, hesitation period and precautions, and also remind consumers to confirm the legal qualifications of insurance institutions and sales personnel. Of course, the insurance in critical illness insurance is no exception.

Physical examination has become a necessary procedure for health insurance.

In the past, when applying for critical illness insurance in health insurance, the insurance company did not have rigid requirements for physical examination, but only conducted random physical examination according to a certain proportion, and conducted physical examination for the insured who did not meet the health conditions and were over 45 years old. However, after the implementation of the Insurance Law, because the new law pays more attention to protecting the rights and interests of the insured, and the new law introduces the incontestable rule, the proportion of insurers' compensation will rise, which will lead to an increase in the operating costs of insurance companies. Insurance companies will raise the threshold of critical illness insurance and require the insured to have a physical examination to prevent the moral hazard of the insured and reduce operating costs.

If the insured fails to tell the truth, the insurance company will have to pay compensation after two years.

Drawing lessons from international practice, the new law adds an "incontestable" clause to the insurance contract, stipulating that "the insurer shall not terminate the contract if it has been more than two years since the date of establishment of the contract". That is, after the insurance contract has been established for two years, the insurance company shall not terminate the contract on the grounds that the applicant has not fulfilled the obligation of truthful disclosure. That is to say, if the insured deliberately conceals some of his illness before purchasing the critical illness insurance, according to the original terms, if the insured has related major diseases in the future, the insurance company can refuse to pay. However, after the implementation of the new insurance law, if this major disease of the insured does not break out within 2 years, and then it does, the insurance company must make compensation. This rule is of great significance to the protection of the interests of the insured under the long-term life insurance contract, which fills the gap in the current insurance law and will also bring cost increase to the insurance company.

There are many methods, such as the second payment, multiple claims and terminally ill claims.

The so-called "second payment" means that the insured is unfortunately diagnosed as one of the 35 major diseases listed in the contract for the first time after 90 days from the effective date of the contract due to an accident, and will receive the first payment for critical illness insurance according to the insured amount, and the insured amount of the main contract will be reduced accordingly, and the policy will continue to be valid; After the expiration of 365 days from the date of the first diagnosis of major diseases, the insured will receive the second critical illness insurance premium according to the insured amount, and the insurance liability will be terminated.

The second claim can make up for the shortcomings of traditional critical illness insurance products, such as "one-time termination of disease protection". For example, the concept of "secondary claims" featured by Xincheng Life Insurance provides secondary claims protection for malignant tumors. No matter whether the malignant tumor is diagnosed for the first time or the second time (including recurrence and metastasis), the maximum insurance amount of 100% is provided each time. In the old insurance law, the insured suffered from serious illness insurance, and the contract was terminated after the insured obtained a claim for illness.

Another example is Taiping Life's "Fu Lu Shuang Zhi", which puts forward the concept that "terminally ill patients can also claim compensation". "For example, if the customer is diagnosed in the hospital and the survival time is less than 6 months, now the hospital can only give some basic drug treatment to alleviate the patient's pain and get the corresponding claims." Personal insurance salesmen who are familiar with "Fulu Shuangzhi" products said that this provision is not limited to major diseases, such as diseases caused by major car accidents, and claims can be obtained, which actually expands the scope of claims.

The coverage of critical illness insurance has been expanded.

Due to the changes in the definition of high disability of critical illness insurance in the new Insurance Law and the description of high disability as a specific disease, the product coverage of critical illness insurance has been expanded. For example, China Life's Hua Dan-Corning Life and Corning Term, which account for more than 40% of the national critical illness insurance market, will be replaced by upgraded products, and their coverage will be expanded. For example, the coverage of the new "Corning Lifelong" critical illness insurance will increase from 2 times to 3 times, and the coverage of critical illness insurance will increase from 65,438+00.

Claims will be smoother and faster.

From the aspect of claim settlement, the new insurance law strengthens and improves the effective protection of the interests of the insured and the insured in a relatively weak position, and modifies or refines the insurer's claim settlement procedure or time limit. Article 22 of the new "Insurance Law" stipulates that: if the insurer believes that the relevant certificates and materials are incomplete according to the contract, it shall notify the applicant, the insured or the beneficiary to supplement them in time; Article 23 stipulates that: after receiving the request of the insured or beneficiary for compensation or payment of insurance benefits, the insurer shall make timely verification, and if the situation is complicated, it shall make verification within 30 days, unless otherwise agreed in the contract; For those who do not belong to the insurance liability, the insurer is required to explain the reasons for refusing compensation.

The critical illness insurance is insured as an additional risk.

According to the person in charge of the personal insurance department of a life insurance company, due to the addition of "non-defense clause" in the new Insurance Law, that is, after the insurance contract has been established for two years, the insurance company will not be able to refuse to pay insurance benefits on the grounds that the insured violates the obligation of truthful disclosure, such as false disclosure, omission of disclosure and concealment of certain facts. Pure critical illness insurance for insurance companies, the risk doubles. Therefore, new critical illness insurance mostly exists in the form of "main insurance+additional insurance". On the one hand, it is for the sake of preventing the moral hazard of the insured and reducing the operating cost, and at the same time it caters to the market demand and the interests of the insured. If the main insurance is critical illness insurance, you are not allowed to participate in dividends according to the regulations of China Insurance Regulatory Commission, so choose a critical illness insurance attached to the main insurance. If the main insurance can pay dividends, the insured can get benefits and critical illness insurance protection at the same time. In addition, under the same coverage and amount, the additional insurance of critical illness insurance is cheaper than the main insurance. Consumers have more room for independent choice.

Critical illness insurance rate will be fine-tuned

As the newly introduced critical illness insurance has expanded the coverage, the compensation risk of insurance companies has increased. At the same time, the new clauses in the new Insurance Law, such as the two-year incontestability clause, the claim in settlement and the change of limitation of action, have increased the operating costs and compensation expenses of insurance companies to some extent. After the operation of the new insurance law, the payout ratio of major diseases of insurance companies may increase by tens of millions of yuan, and the newly revised insurance premium rate may need to be raised. For example, if Taiping Life's "Fulu Shuangzhi" product is a 30-year-old male, the insured amount is 200,000 yuan, and the price of the original product is about 6,060 yuan, while the price of the new product is about 6,340 yuan, with a price increase of about 4.60%. According to this price, if you buy a new product, the total overpayment for 30 years is about 8400 yuan, equivalent to.

You can also get compensation during the observation period.

An insurance contract established in accordance with the law takes effect as soon as it is established. The applicant and the insurer may agree on additional conditions or time limit for the contract to take effect. This means that the insurance company cannot shirk its responsibility when an accident occurs during the observation period.

Mr. Li insured himself for health insurance and extra hospitalization expenses of an insurance company. On July 3, he was hospitalized for gastrointestinal diseases. After leaving the hospital, Mr. Li came to the insurance company to apply for a claim. According to the relevant provisions of the old insurance law, the insurance company said that since the onset time of Mr. Li was within the observation period of 90 days after the policy came into effect, the insurance company would not compensate.

However, the relevant provisions of the new "Insurance Law" stipulate: "An insurance contract established according to law shall take effect upon its establishment." Considering the necessary underwriting link between premium payment and the formal entry into force of the policy, the new insurance law also stipulates: "The insured and the insurer may attach conditions or deadlines to the effectiveness of the contract."

At the same time, China Insurance Association encourages life insurance companies to introduce the special rules of "temporary contracts" in view of the new provisions of the new Insurance Law on "the time when insurance contracts are established and take effect". An insurance company may, according to the actual situation, provide temporary protection for consumers to protect the interests of the insured and beneficiaries, or issue a notice of refusal to insure and refund the insurance premium during the period from the time when the applicant pays the initial insurance premium to the time when he agrees to underwrite.

Further reading: How to buy insurance, which is good, and teach you how to avoid these "pits" of insurance.