Micro-insurance is punished: the "pit" of Internet insurance

How far is 3 yuan premium from 6 million medical claims?

The answer is, separated by two "modifiers".

/kloc-in August, 2007, Wei Min Insurance Agency Co., Ltd. (hereinafter referred to as "Weibao") was fined120,000 yuan for illegal marketing, and its related responsible persons were also fined 40,000 yuan.

People in the insurance industry said that the illegal marketing of micro-insurance is related to its development model. Micro-insurance is essentially an online intermediary platform. Insurance companies can sell their products on this platform after agreeing to cooperate well with this platform. This sales model belongs to the emerging insurance online sales, that is, "insurance+internet", which saves the link of third-party sales staff and is a trend of the future development of the insurance industry.

However, it is worth noting that after reducing the third-party sales links, the insured needs to master the relevant terms and information when browsing insurance products and applying for insurance. The insiders believe that there are some problems in this model, such as misleading sales, difficulties in claims communication, and insufficient insurance knowledge of the insured, which may easily lead to disputes in the future, and consumers may also bear risks.

There is a mystery in propaganda.

According to the claim report of Micro-insurance in 20 19, the highest claim case of its million medical insurance is 705,000 yuan, which is quite different from the advertised upper limit of 6 million claims. In addition, according to the statistical bulletin of health development in 20 19, the per capita hospitalization expenses of national tertiary public hospitals in 20 133 13.3 yuan are far from "one million".

In fact, according to the insurance clause of micro-insurance million medical insurance, its reimbursement items are limited. Only outpatient treatment expenses related to hospitalization can be reimbursed, but daily outpatient treatment cannot be reimbursed. Therefore, millions of medical insurance is also called "hospitalization insurance" in the insurance industry.

The setting of "1 0,000 deductible line" blocked hospitalization reimbursement for minor illnesses, which means that the use of millions of medical insurance can only be used for serious illness hospitalization.

"the insured"

Millions of medical insurance disputes have occurred one after another.

Many complainants said on the complaint platform that they chose to insure after seeing the advertisement of micro-insurance for millions of medical insurance. However, when they renewed the fee automatically in the second month, they found that the fee was deducted from 193 yuan to 36 1 yuan, and some users even turned on the automatic fee deduction option without knowing it.

In the absence of communication with weibao customer service, many policyholders choose to initiate complaints on the complaint platform. Some users questioned that the first monthly premium was 1 yuan, but the second monthly premium was automatically deducted to 193 yuan. If calculated at this price, the insured does not actually enjoy a great discount. In addition, I gave myself a small insurance, and I didn't contact the account manager. I didn't receive the exact amount of micro-insurance before renewing the fee, and I was also suspected of violating the rules.

In response, Weibao responded that mobile phone broken screen insurance is a gift insurance provided by Weibao, and users can receive it for free after recharging with WeChat mobile phone. Mobile phone screen damage insurance provides mobile phone screen damage replacement protection, and the protection itself will not charge any fees. As the insured, the user will use the mobile phone recharge platform to carry out related operations after recharging to join the group insurance. The "acceptance" here is equivalent to the insurance of "joining" and "confirming acceptance" groups. The insured is the platform and the insured is the user.

One mistake in life.

Avoid misleading propaganda and misunderstanding deviation, and the insured may also fall into the column of "health does not tell the truth". Because once the "health notification form" is concealed or misreported, it will be recognized as "sickness insurance" by the insurance company, and the insurance company will have reason to refuse to pay compensation in the future. People in the insurance industry believe that "health notification" has a certain threshold in the specific operation of insurance and requires operators to have basic insurance professional knowledge.

"I have been exposed to the insurance products of banks myself, so I also know something about micro-insurance medical insurance." By looking at the insurance clauses, Ms. Liang found that her father's conditions could cover millions of medical insurance with micro-insurance, so she chose to cover them with micro-insurance. However, she also mentioned that because of her experience in insurance sales, she is familiar with the relevant procedures of insurance purchase and will try to be as detailed as possible when filling in the information. However, many ordinary people do not have relevant knowledge reserves, and it is easy to stumble on "truthful health notification".

Insurers of insurance companies need to check the risks of all people with the same disease in the future. If the risk of disease is high, the insurance company will choose to refuse insurance. However, when the insured is operating on the online sales platform, he may hear from the doctor that the problem is not serious, or he has a vague memory of his medical examination report and did not fill it out truthfully in the "truthfully inform" option. In the future, the probability that the insured will be refused compensation when applying for compensation is very high, and this kind of refusal is reasonable, so the insured can only choose to accept it, as explained by the insurance salesman mentioned above.

However, in the eyes of people in the insurance industry, "insurance+Internet" still has its competitive advantage. For those who are familiar with insurance, they really enjoy the benefits brought by the decline in premiums. But for the vast majority of people who only read propaganda slogans, it is possible to step on the pit, which requires strengthening the education of insurance knowledge for ordinary people.

Recently, the Consumer Protection Bureau of China Banking Regulatory Commission released the complaint report of insurance consumers in the second quarter of 2020. According to the circular, in the second quarter of 2020, the China Banking Regulatory Commission and its dispatched offices * * * received a total of 33,732 complaints about insurance consumption involving insurance companies, including life insurance companies17,532, with a year-on-year increase of 46.03%, accounting for 5 1.97% of the total complaints. Among the complaints involving life insurance companies, there were 2328 claims disputes, accounting for13.28% of the total complaints of life insurance companies; There were 7654 sales disputes, accounting for 43.66%.

The above-mentioned insurance sellers believe that there may be more claims disputes about micro-insurance million medical insurance in the future. "Because the insured bought millions of medical insurance in the case of illegal publicity of micro-insurance, and I don't know if they will hide anything when filling out the health notification form, many insured people have not yet entered the claims stage, and there may be more complaints in the claims stage, because serious illness is usually several years later, and the amount of claims will come up, and the amount of complaints will follow."

In this regard, Weibao said that the issue of health notification has been adjusted on 20 19 1 1, and the company has rectified the relevant issues one by one, implemented the people and improved the system process.