根据通报,在产品核查中,银保监会共通报了产品设计、产品条款表述、产品费率厘定以及其他等方面发现的多项问题。

According to the circular, in the product verification, the CBRC has reported a number of problems found in product design, product term formulation, product rate determination and other aspects.

在产品设计问题上,一是产品责任设计与产品定义不符。如,英大泰和某疾病保险,保险责任中包含了生存金给付责任,与疾病保险定义不符;二是产品保障功能弱化。如,和谐健康、人保健康某护理保险,产品为万能型,护理责任风险保费占整体保费比例较低。

On the issue of product design, one is that the product responsibility design does not conform to the product definition. For example, Ying Datai and a disease insurance, insurance liability includes survival gold payment liability, and disease insurance does not agree with the definition; the second is the weakening of product protection function. For example, harmonious health, PICC health a nursing insurance, the product is universal, nursing responsibility risk premium as a low proportion of the overall premium.

产品条款表述问题方面,一是条款表述与法律规定不符。如,瑞泰人寿、瑞华健康、中德安联、国华人寿等公司部分产品条款中关于具有管辖权的法院范围约定,与《中华人民共和国民事诉讼法》关于地域管辖的规定不符。二是条款表述不清晰。如,信美相互和招商仁和某医疗保险,产品为一年期非保证续保产品,但续保条款中包含“自动续保”表述,存在“短险长做”风险。三是条款表述易引发纠纷。如,华夏人寿、人保健康、招商信诺、海保人寿、中美联泰大都会、中意人寿、复星联合健康和德华安顾等公司报送的部分健康保险产品,条款中约定将等待期出现的症状或体征作为在等待期后发生保险事故时的免责依据,而症状与体征均无客观判定标准,侵害消费者利益。

The first is that the terms are not in accordance with the provisions of the law. For example, the terms of some products of Ruitai Life, Ruihua Health, Sino-German Allianz, Guohua Life, etc., concerning the scope of the court with jurisdiction, are not in accordance with the provisions of the Civil Procedure Law of the People's Republic of China on regional jurisdiction. Second, the terms are unclear. For example, Xinmei Mutual and China Merchants and a medical insurance, the product is a one-year non-guaranteed renewal product, but the renewal clause contains \"automatic renewal\" expression, there is a \"short risk long do\" risk. Third, clause expression is easy to cause disputes. For example, some of the health insurance products submitted by Huaxia Life, PICC Health, China Merchants Xinnuo, Haibao Life Insurance, Sino-American Union of Thailand, Sino-Italian Life, Fosun United Health and Dehuaan Gu, etc., are stipulated in the terms and conditions that the symptoms or signs of the waiting period will be used as the basis for exemption from the occurrence of insurance accidents after the waiting period, and the symptoms and signs are not objectively judged to infringe upon the interests of consumers.

在产品费率厘定问题上,短期健康保险产品有费率调整表述。如,太平洋人寿某医疗保险,产品条款中含有续保时可能调整产品费率的表述,与《健康保险管理办法》要求不符。

On the issue of product rate determination, short-term health insurance products have a rate adjustment statement. For example, a health insurance policy for Pacific Life contains a statement that the product rate may be adjusted at the time of renewal, which is not in accordance with the requirements of the Health Insurance Regulations.

其他方面还存在备案材料报送不规范和备案材料填写不规范等问题。如,平安健康某2款健康保险产品报送的部分材料不属于产品备案材料范畴;复星联合健康报送的某5款产品,费改信息表中偿付能力数据未区分综合和核心偿付能力充足率;太平养老某重大疾病保险,费改信息表中近5年公司投资收益数据未更新。

There are other issues such as non-standard filing materials and non-standard filing materials. For example, some of the materials submitted by a certain 2 health insurance products do not belong to the category of product filing materials; the solvency data in the information table of Fuxing joint health report of a certain 5 products, the information table of fee change information does not distinguish between comprehensive and core solvency adequacy ratio; Taiping pension a major disease insurance, fee change information table in the company investment income data has not been updated in the last five years.

银保监会还在现场调查中发现,2019年3月至5月中旬,海保人寿通过易康吉保险经纪有限责任公司,在深圳市随手科技有限公司旗下网络平台销售好生活借款人意外伤害保险过程中,存在两方面问题:

The CBRC also found in its on-site investigation that between March and mid-May 2019, Haibao Life, through Yi Kangji Insurance Brokerage Co., Ltd., had two problems in the process of selling good life borrowers'accidental injury insurance on the network platform of Shenzhen Handy Technology Co., Ltd.:

一是除根据地区、职业等因素进行费率浮动外,还参考了客户的借款期限、借款金额、资产、信用状况等因素,没有完全按照经备案的保险条款对费率浮动进行管理。

First, not only according to the region, occupation and other factors to carry out rate fluctuations, but also refer to the customer's borrowing period, loan amount, assets, credit status and other factors, not completely in accordance with the insurance clause on record to manage the rate fluctuations.

二是与易康吉经纪约定的佣金费用率大幅高出精算报告中的预定费用率水平。海保人寿对上述问题进行了整改,并对相关责任人进行了内部问责。

The second is that the commission rate agreed with the Yi Kang Ji is significantly higher than the expected rate in the actuarial report. Haibao Life has rectified the above problems and carried out internal accountability to the relevant responsible persons.

银保监会指出,《健康保险管理办法》(银保监会令2019年第3号)实施后,对健康保险业务提出新的要求。根据《健康保险管理办法》及其他监管规定,各公司应关注如下四项问题:

The CBRC pointed out that new requirements for health insurance business were put forward after the implementation of the Health Insurance Management Measures (CBRC Order No.3 of 2019). Under the Health Insurance Regulations and other regulatory provisions, companies should focus on the following four issues:

二是含有保险续保条款的健康保险产品,应当在产品精算报告中说明保证续保的定价处理方法和责任准备金计算办法。

Second, health insurance products with insurance renewal clauses should state in the product actuarial report the pricing treatment method and liability reserve calculation method for the guaranteed renewal.

三是保险公司销售健康保险产品,不得强制搭配其他产品销售。部分公司在条款中约定消费者不得单独解除附加险,或者约定该产品保险金给付以其他产品保险金是否给付为前提条件,涉嫌侵害消费者利益。

Third, insurance companies to sell health insurance products, may not be forced to match other products to sell. Some companies have stipulated in the terms that consumers are not allowed to release the additional insurance separately, or have agreed that the insurance payment of the product is conditional on whether the insurance payment of other products is paid or not, which is suspected of harming the interests of consumers.

四是产品备案材料中的总精算师声明书和法律责任人声明书等材料中,关于原保监会的相关表述应按机构改革后最新名称进行调整。

Fourth, the statement of the chief actuary and the statement of the legal responsible person in the product filing materials should be adjusted according to the latest name after the institutional reform.

银保监会强调,各人身保险公司应当加强对产品开发的规范管理,严格对照历次通报内容进行自查,加强对产品条款制定、费率厘定等工作审核把关,确保产品依法合规。各公司要高度重视消费者权益保护工作,不得设置不合理的免责条款缩小保险责任范围,不得设置不合理的约定限制消费者合法权利,不得设置不合理的条款表述为误导销售提供便利。

The CBRC stressed that all personal insurance companies should strengthen the standardized management of product development, conduct self-inspection in strict reference to the contents of previous circulars, and strengthen the examination and control of the formulation of product terms and rates, so as to ensure that products comply with the law. All companies should attach great importance to the protection of consumers'rights and interests, must not set unreasonable exemption clauses to narrow the scope of insurance liability, must not set unreasonable agreements to restrict consumers'legal rights, and must not set unreasonable terms to provide convenience for misleading sales.

与此同时,各人身保险公司不得利用通报内容进行行业诋毁,不得将通报内容作为营销炒作、不正当竞争工具。违反相关规定产生不良影响的,银保监会将严肃追究相关公司和信息传播人员责任。(本文来自澎湃新闻,更多原创资讯请下载“澎湃新闻”APP)

At the same time, all personal insurance companies shall not use the contents of the circular to discredit the industry, and shall not use the contents of the circular as a marketing hype and unfair competition tool. Those who violate the relevant regulations have adverse effects, the CBRC will seriously investigate the responsibility of the relevant companies and information dissemination personnel. (For more original information, please download the \"Surging News\" app)


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