Recently, NIC released its 2021 annual report on claims service. The data shows that the company provided claims service for 2.86 million people in 2021***, with a total of 14 billion yuan paid out. Critical illness insurance claims amounted to about 5.44 billion yuan, accounting for about 38.9% of the total claim amount, while medical insurance accounted for more than 90% of the claim types.

NHI said that the company has always adhered to the concept of "finding reasons for customers to pay", relying on technology to empower, optimize the claims service, every minute and every second to pay claims, and is committed to providing customers with a warm claims service.

Average daily claims payment exceeded RMB 38.4 million

In 2021, NWCL paid out RMB 14 billion in claims, a year-on-year increase of about 19.7%, with an average daily claims payment of more than RMB 38.4 million; the cumulative premium waiver amounted to RMB 789 million, with about 12,000 policies enjoying protection without premium payment. The average time taken to settle a claim is only 0.55 days from application to settlement.

Medical insurance accounted for over 90% of claims. The company has improved the claim processing time, and the average time from application to case closure is 0.27 days for small medical insurance claims of less than 5,000 RMB, with a 5-day case closure rate of about 99.4% and a claim recovery rate of about 99.3%. The second is critical illness insurance. Although it accounts for less than 10% of the claims, the claim amount of 5.44 billion RMB is close to 40% of the total claim amount, and the number of claims is about 63,000, which shows the importance of raising risk awareness and strengthening the protection of critical illnesses.

The report points out that the oldest customer at risk is 97 years old, and the youngest is only 3 months old, so it is especially necessary to configure insurance products that cover the entire life cycle. The largest single payout amount for million-dollar medical insurance products is 620,000 RMB, and the largest number of payouts reaches 34. For major disease insurance products, Ms. Z, a client from Henan, has been paid out for mild disease once and severe disease twice, highlighting the protection advantages of high coverage and multi-payout products.

Malignant tumors account for a higher proportion of the occurrence of critical illnesses

The report provides a special analysis of the composition of critical illness claims.2021, the company's critical illness insurance claims amounted to 5.44 billion yuan, an increase of about 35.8% year-on-year.

In terms of the gender composition of critical illness claims, the proportion of women is about 59.5%, 19 percentage points higher than that of men, showing that women are more aware of risks and the probability of incurring critical illnesses is slightly higher than that of men. From the age distribution point of view, the age group of people insured against critical illnesses is concentrated in the age group of 40 to 59 years old, therefore, it is strongly recommended to take critical illness insurance as the "standard" for people in their middle age, and to do a good job of health planning in advance. The company's main goal is to provide the best possible service to its customers," he said. "The company's main goal is to provide the best possible service to its customers," he said.

Malignant tumors still occupy the first place in critical illness claims, and female malignant tumor claims are more concentrated, accounting for about 74%, while the main reason for male critical illness claims is malignant tumors, accounting for about 48%, followed by cardiovascular disease, accounting for about 16%. From the point of view of the site of occurrence, the male high incidence of malignant tumors site in order of lungs, thyroid, liver, women are thyroid, breasts, lungs. Minors high incidence of critical illness payout reasons in order of leukemia, epilepsy, thyroid malignant tumors. It can be seen that targeted configuration of critical illness insurance or cancer insurance is very necessary.

The report also points out that traffic accidents, high fall, drowning is the main cause of accidental death.

Technology helps claims quality and efficiency

While AI, big data and other technological forces enter the claims service and rapidly improve the efficiency of claims, NWS also continues to optimize the temperature of the claims service and improve the customer claims experience. 2021, the company's AI intelligent claims about 447,000 cases, the amount of compensation paid 9.7 billion dollars.

The company's first claims direct payment project was launched in Zhengzhou, Henan Province at the end of November 2021, which realized one-stop settlement of medical insurance and commercial insurance upon discharge from hospitals, truly achieving "zero-waiting for claims". In the future, the company will continue to increase service innovation, in more areas to open up the claims service "last kilometer".

The Critical Illness Sympathy First Claim Service continued to unleash professionalism and warmth, with a total of 4,282 claims paid out, amounting to approximately RMB 330 million. This service enabled customers unfortunate enough to suffer from malignant tumors to receive door-to-door sympathy and claims guidance in the early stages of their illnesses, and to alleviate the pressure on customers' medical funding with fast payouts.

The company practiced the original spirit of "finding reasons for customers to pay" by hiring experts who are chief physicians or above from authoritative tertiary hospitals in China to carry out consultation on difficult disputes, and provided 124 departmental consultations with experts throughout the year.

At the scene of major accidents, there is always the figure of NWS claim service personnel. The company has launched 83 emergency responses to major emergencies and paid out 7.33 million yuan.

Claims integrity bill transparently presents the amount of claims handled by the salesman, the number of cases, the rate of compensation and other key data during the year, to promote their continuous improvement of customer service professionalism, enthusiasm, covering more than 140,000 people, reading volume exceeded 1 million times.

Actively serving the nation's economy and people's livelihood

While providing customers with professional claims service, the company actively fulfills its social responsibility by stepping forward in the fields of insurance poverty alleviation, epidemic relief and other areas, and plays a positive role as the social "stabilizer" of the insurance enterprise.

By the end of 2021, NWS had launched a series of precise poverty alleviation projects in 36 y impoverished areas in 12 provinces and autonomous regions, of which, the insurance poverty alleviation project had provided insurance protection programs for more than 50,000 impoverished people with a total sum insured of over 5 billion RMB. The large-scale public welfare action of caring for national sanitation workers continues. As of the end of 2021, the project has covered 158 cities nationwide, gifted accidental injury insurance to more than 900,000 sanitation workers, and completed a total of 284 claims, with a cumulative total of 25.135 million yuan paid out.

To help fight the epidemic, the company developed the Vaccine Guardian Medical Accident Insurance product, which protects against abnormal reactions that occur after preventive vaccination, and safeguards the new crown vaccination.

Based on the company's achievements in claims service, NWS was awarded the title of "Insurance Company of the Year with Excellent Claims Service" in the "2021 Excellence in Financial Enterprises Ceremony" organized by The Economic Observer at the end of 2021. NHI said that the company will adhere to the original intention of "returning to the origin of protection", continue to refine its professional operation and management capabilities, and supply market-leading products and services, so as to weave a life-cycle protection network for the general public.