Measures for the Administration of Health Insurance No.3 (20 19) issued by the Insurance Regulatory Commission of the Bank of China came into force on 20 19 12 1.
Administrative measures on health insurance/Xinwen/2019113/content _ 5451534.htm.
Next, it focuses on the Circular [2021] No.7 of the General Office of China Banking Regulatory Commission on regulating short-term health insurance business.
The relevant issues concerning the regulation of short-term health insurance business are hereby notified as follows:
1. The short-term health insurance regulated in this circular refers to the health insurance that the insurance company sells to individuals with an insurance period of one year or less and does not include the guarantee renewal clause. Except for group insurance business.
Two. Short-term health insurance products developed and designed by insurance companies should aim at improving people's health protection level and meeting multi-level and diversified health protection needs, and continuously expand the coverage of health protection and health management services.
Short-term health insurance products developed by insurance companies shall clearly and unambiguously specify the insurance period, insurance liability, liability exemption, claim settlement conditions, surrender agreement, premium payment method, waiting period setting, insurance amount, deductible, compensation ratio and other product key information in the insurance clauses.
Three, the short-term health insurance products developed by the insurance company contain the responsibility of renewal, it should be clearly stated in the insurance clause that "renewal is not guaranteed". There is no guarantee that the renewal terms will at least include the following contents:
The insurance period of this product is one year (or no more than one year). At the expiration of the insurance period, the insured needs to re-apply to the insurance company for the product, and with the consent of the insurer, pay the insurance premium and get a new insurance contract.
An insurance company shall not use such words as "automatic renewal", "commitment renewal" and "lifetime limit" which are easily confused with long-term health insurance in terms of short-term health insurance products and promotional materials.
Four, the insurance company shall scientifically and reasonably determine the price of short-term health insurance products. The actuarial assumptions used in product pricing shall be based on empirical data, and shall not be arbitrarily agreed or deviate greatly from the actual operation. Insurance companies can determine differentiated product rates according to different risk factors, and sell short-term personal health insurance products in strict accordance with the approved or filed product rates.
Insurance companies should disclose the overall comprehensive payout ratio index of individual short-term health insurance business in official website every six months. Among them, the payout ratio indicators for the first half of the year should be disclosed no later than the end of July each year; The annual payout ratio index shall be disclosed no later than the end of February of the following year. The calculation formula of comprehensive payment rate index is as follows:
Comprehensive payout ratio = (indemnity expenditure after reinsurance+outstanding indemnity reserve after reinsurance) ÷ earned premium after reinsurance.
Among them, the outstanding claims reserve includes the outstanding claims reserve (IBNR reserve).
Five, the insurance company shall, according to the actual level of medical expenses, claims experience data and other factors, reasonably determine the short-term health insurance product rate, deductible, payment ratio and insurance amount. An insurance company shall not set an inflated insurance amount that seriously deviates from the data base of claims experience.
6. When calculating the minimum cash value of short-term health insurance products, the insurance company shall adopt the calculation method of unexpired net premium. The calculation formula is: minimum cash value = net premium ×( 1-m/n), where m is the effective days and n is the days of insurance period. If the elapsed date is less than one day, it shall be counted as one day.
7. Where an insurance company develops and designs short-term health insurance as the main insurance product, it shall not force insurance consumers to purchase other products of the company at the same time as purchasing the main insurance product.
When an insurance company develops and designs short-term health insurance into additional insurance products, it shall clearly inform the insurance consumers of the main insurance products corresponding to the additional insurance, and the insurance consumers shall decide whether to purchase the product portfolio independently.
An insurance company shall not restrict the insured's right to terminate the additional insurance contract alone in the terms of additional insurance products.
Eight, insurance companies should strengthen the management of sales staff, strictly regulate sales behavior. An insurance company shall guide insurance consumers to read the insurance clauses completely in a reasonable way, so that the insured can fully understand the information such as insurance products and services.
When an insurance company sells short-term health insurance products, it shall provide insurance consumers with "Instructions for Insurance of Short-term Health Insurance Products", and focus on the following contents:
(1) The obligation of the applicant to tell the truth and the consequences of not telling the truth;
(2) Insurance liability and exclusion liability;
(3) insurance period;
(4) the insured amount;
(5) deductible;
(6) Compensation ratio;
(7) waiting period;
(eight) the age of insurance is related to the level of premium. ;
(9) Other matters stipulated by China Banking Regulatory Commission.
Nine, insurance companies should strengthen the underwriting and claims management of short-term health insurance products, standardize the setting of health information, and the setting of health information shall not violate general medical knowledge. An insurance company shall guide insurance consumers to fulfill the obligation of truthful disclosure.
An insurance company shall not unreasonably refuse to pay compensation. It is strictly forbidden for insurance companies to affect the normal and reasonable claims of insurance consumers by setting assessment indicators such as product rejection rate, so as to make up for the actual operating losses caused by unreasonable and unscientific product pricing assumptions and infringe on the interests of consumers.
X. If an insurance company decides to stop selling short-term health insurance products, it shall disclose the specific reasons, specific time and follow-up service measures of stopping selling products to the insurance consumers through the company's official website, instant messaging tools and other ways that are easy for the public to know, and continue to provide guarantee services for the insurance consumers who have purchased the products during the insurance period, and at the same time provide insurance transfer suggestions when the insurance period expires.
If an insurance company voluntarily stops selling insurance products, it shall disclose relevant information at least 30 days before stopping selling the products. If an insurance company is ordered by the regulatory authorities to stop selling due to illegal product design and other issues, it shall disclose relevant information within 3 days from the date of stopping selling. After disclosing the relevant information about the suspension of product sales, the insurance company shall notify the insured of each valid policy in a reasonable way.
The insurance company shall promptly clean up and cancel the short-term health insurance products that have stopped selling. If an insurance company resells products that have been stopped, it shall re-submit the insurance products to the regulatory authorities for approval or filing.
An insurance company shall, before March 3 1 every year, disclose the suspension of sales of individual short-term health insurance products in the previous three years and the number of effective policies for each product in the company's official website.
Insurance companies engaged in short-term health insurance business may not be restricted by the relevant provisions in the first paragraph of Article 4 of the Notice of China Insurance Regulatory Commission on Strengthening the Supervision of Life Insurance Products (No.2065199).
Eleven, China Insurance Association should strengthen the short-term health insurance product pricing, underwriting claims and other industry basic standards, and promote the scientific and standardized development of short-term health insurance business.
Twelve, the insurance company in violation of the relevant provisions of this notice, the China Banking Regulatory Commission will be held responsible for the insurance company and the relevant responsible person. If the circumstances are serious, the CBRC will take administrative punishment measures according to law, including ordering to stop accepting new business and revoking the qualifications of relevant personnel.
Thirteen. Short-term health insurance products that have been approved or filed by insurance companies before the issuance of this notice and do not meet the requirements of this notice shall stop selling before 202 1.