ZhongAn Health Insurance Releases 2019 Claims Service Report: Over 80% of Cases Filed Online

Recently, ZhongAn Insurance released its 2019 Annual Health Insurance Claims Service Report (hereinafter referred to as the “Report”). According to the data in the Report, in 2019, the proportion of online applications for health insurance claims with ZhongAn Insurance reached 83%, and the three regions with the highest claim incidence rates were Shanghai, Zhejiang, and Beijing. Driven by technology and committed to delivering high-quality, empathetic claims services, ZhongAn Health Insurance achieved a case closure rate of 97% in 2019, with individual insurance claims increasing by 38%. The reporting-to-payment cycle for cases under RMB 10,000 was shortened by 26% year-on-year, and the fastest case closure through direct claims connectivity service took just 1 minute and 6 seconds.

As China’s first internet insurance company, ZhongAn has remained true to its original mission of “providing insurance with warmth.” In the health insurance sector, it consistently adheres to technology-driven innovation, delivering scenario-based, intelligent, and personalized protection value and service experiences.

Committed to building a “national health insurance” for 100 million people, ZhongAn Health’s ecosystem services had reached over 16 million users by December 2019, with more than 10 million insured individuals covered under its ZhenXiang series. Leveraging warm technology to illuminate new claims services, ZhongAn Health utilizes technology-driven solutions to provide customers with simple, efficient, and compassionate claims experiences.

According to the Report, in 2019, 83% of ZhongAn health insurance claims were filed online. By leveraging technologies such as big data, intelligent risk control, automated claims adjustment, and customer service robots to reshape the insurance value chain, ZhongAn achieved intelligent and automated operations across the entire process—including underwriting, policy issuance, policy administration, claims settlement, and customer service—thereby significantly enhancing operational efficiency.

In claims processing, the introduction of OCR technology and direct medical data connectivity has enabled intelligent deconstruction of medical documents, significantly reducing data entry costs. Furthermore, automated claims adjudication integrates insured patients’ visit information with compensation standards to automatically calculate payout amounts. This has raised the automated adjudication rate to 94%, substantially improving claims efficiency and making insurance services faster.

“The Report” shows that hospital-direct claim cases can be settled in as fast as 1 minute and 6 seconds, with the settlement cycle for claims under RMB 10,000 shortened by 26% year-on-year. In fact, ZhongAn’s standardization and automation have covered all aspects of the claims process, achieving the goals of efficiency, convenience, and high quality.

Technological applications have streamlined the claims process, enabling insurance products to deliver both speed and compassion. As ZhongAn Health’s flagship offering, the “Zunxiang” series has been hailed by netizens as the “National Health Insurance.” It aims not only to address the challenge of unaffordable medical care but also to provide users with compassionate service. Services such as advanced medical payments and green-channel access for critical illnesses effectively alleviate users’ urgent needs. According to the Report, in 2019, the highest advanced payment amount for a single case reached RMB 1,194,200, with the maximum number of advanced payments for a single case reaching 23.

While providing the first insurance policy to the new generation of users, we are also committed to supporting their healthy growth with warm and reliable protection. In November and December 2019, ZhongAn Health launched the “1-Yuan Micro-Philanthropy Campaign to Support Children with Critical Illnesses,” attracting nearly 70,000 participants. ZhongAn Health promptly delivered its care and support to those in need.

Five-year-old Xiao Z from Jingdezhen, Jiangxi Province, was diagnosed with medulloblastoma, the most aggressive type of malignant glioma. Her treatment, including surgery, hospitalization, seven cycles of chemotherapy, and 31 sessions of radiotherapy, has incurred costs exceeding RMB 500,000. ZhongAn Insurance promptly provided efficient claims settlement and advance payment services. Taking her family’s circumstances into account, the insurer collaborated with the Shanghai Charity Foundation to provide financial aid, thereby alleviating the family’s economic and psychological burden to the greatest extent possible, supporting Xiao Z’s journey toward recovery, and reigniting hope for her family.

Asking one more question can help solve a major problem for users. Listening a bit more can build a bridge of trust with them. The Zunxiang Yisheng Public Welfare Fund also delivers special warmth and care to patients suffering from critical illnesses.

According to the "Report," the top five regions with the highest claim incidence rates are Shanghai, Zhejiang, Beijing, Guangdong, and Jiangsu. The Yangtze River Delta region accounts for over 60% of all claims. Female-related cases constitute 53.7%, significantly higher than those involving male users.

Furthermore, an analysis of the age distribution reveals that users aged 0–4 years account for 17.4% of cases, the highest proportion among all age groups; this demographic is particularly prone to respiratory diseases. In terms of overall claims data, the top ten most frequent causes include respiratory tract infections, suboptimal health status, oral diseases, chronic gastritis, dermatological conditions, hypertension, and cervical spondylosis.

“An analysis of high-frequency insurance claims reveals that most are associated with policyholders’ suboptimal health status.” ZhongAn Health claims experts analyzed and recommended that the younger generation should cultivate awareness of health management. During the “2019 National Cancer Prevention and Control Publicity Week,” ZhongAn and NetEase jointly introduced the concept of “Health Quotient (HQ)” and launched the “Put Health Quotient in the Spotlight” initiative. This campaign calls on middle-aged and young adults to raise their Health Quotient, abandon unhealthy lifestyles and habits, establish scientific self-health management models, develop a comprehensive and holistic understanding of health, and promote evidence-based approaches to self-health management.

To provide users with warm and attentive health management services, ZhongAn Internet Hospital has specially launched the “Health Management” feature. This function records personal data such as blood glucose levels and daily step counts, helping users cultivate healthy habits in their daily lives. Additionally, free online consultations are available to offer professional health advice.