Currently, various insurance institutions have basically disclosed their claims reports for 2025. From the cost protection of daily medical treatment, safety protection during travel, to risk mitigation in the event of sudden disasters, the claims reports from various insurance companies not only clearly outline the high-frequency risk scenarios in people's lives but also intuitively demonstrate the insurance industry's relentless exploration in optimizing claims services and enhancing service efficiency.
As the role of technological means in the claims process gradually expands, the service level of personal insurance claims has further improved, with approval rates generally at 99% and above. Meanwhile, innovative models such as direct hospital payments and AI technology empowerment are accelerating implementation, fundamentally solving the problem of &#34;out-of-pocket expenses&#34; and promoting a comprehensive upgrade of insurance services to &#34;fast, accurate, and warm.&#34;
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Initiating the &#34;Speeding Up&#34; Competition
Data shows that in 2025, China's insurance industry will have original insurance claims expenditures of 2.44 trillion yuan, a year-on-year increase of 6.2%. With the continuous growth of industry claims expenditures, what will be the performance of various institutions? Currently, the claims reports for 2025 from various insurance companies have basically been disclosed, and indicators such as claims speed and payout rate that consumers care about are becoming clear.
First, looking at the approval rate indicators, most insurance companies that disclosed this data maintain an approval rate of 99% and above, with some small and medium-sized insurance companies focusing on niche areas achieving approval rates of over 98%. Many institutions have small claims approval rates exceeding 99.9%, with Great Wall Life Insurance's approval rate at 99.18% and China Merchants Life Insurance's approval rate reaching 99.8%.
Not only is the payout rate at a high level, but &#34;speed&#34; is also a keyword in the claims reports of various insurance companies, as they continue to &#34;compete&#34; on speed. For example, Ping An Life Insurance's Beijing branch mentioned that the company achieved a reduction of 190,000 physical material cases through online claims services throughout the year, accounting for 88%, significantly reducing customer trips, allowing claims to be easily completed online.
The significant improvement in the quality and efficiency of claims services is inseparable from the deep empowerment of technology. It is not difficult to find that keywords such as intelligence and artificial intelligence frequently appear in the claims reports of various insurance companies, promoting more optimized claims processes, simpler procedures, and shorter timeframes.
This technology-driven service revolution is pushing the industry towards a true &#34;win-win&#34; situation. Industry observer Hong Shibin analyzed that the application of technological means such as AI claims and online claims simplifies the claims process for consumers, shortens processing time, and enhances service experience; for insurance companies, it improves operational efficiency, reduces labor costs, and enhances risk control capabilities.
Direct payment channels are accelerating to open up
&#34;For hospitalization, I first have to pay tens of thousands or even over a hundred thousand yuan in medical expenses out of my own pocket, and after discharge, I still have to sort out a pile of medical records and invoices, running back and forth to the insurance company to complete the reimbursement. It's common to be tossed around for one or two months.&#34; Wang Jia (pseudonym), a resident of Beijing, expressed the common troubles of many commercial health insurance policyholders
Currently, commercial health insurance generally adopts the traditional model of &#34;patients pay upfront and reimburse after discharge.&#34; Patients not only face pressure on cash flow but also spend a lot of time organizing documents and making trips back and forth.
To effectively reduce the burden on patients seeking medical care and optimize the medical experience, the insurance industry is continuously exploring ways to bridge the &#34;last mile&#34; between medical and insurance services.
For example, Ping An Life Insurance North Branch stated that the company is vigorously expanding its direct compensation business, allowing customers to apply through the &#34;Golden Steward App&#34; and settle directly upon discharge, greatly enhancing customer experience. Tencent WeSure has partnered with WeChat Pay and others to pilot the &#34;Commercial Insurance Direct Payment&#34; quick channel in WeChat Pay scenarios. Under this model, users can complete both medical insurance reimbursement and commercial insurance claims directly through WeChat Pay at the time of discharge, achieving &#34;claims upon discharge.&#34;
&#34;The application of hospital direct compensation reduces the pressure of upfront payments for consumers and simplifies the reimbursement process; for insurance companies, it optimizes service processes, enhances the perception of insurance protection, and is beneficial for further increasing insurance penetration,&#34; analyzed Hong Shibin.
However, for hospitals, building a one-stop settlement system on top of the existing medical insurance settlement system does not offer good cost-effectiveness. &#34;Top hospitals have always had no shortage of patients, and they are not actively interested in integrating into the commercial insurance settlement system,&#34; said an executive from a leading insurance company.
Indeed, the backend systems used by various hospitals and insurance companies are inconsistent, and the technical standards and interface specifications vary, making complete data integration objectively challenging. However, no matter how many obstacles there are, they cannot stop the industry's determination to close the service loop. Driven by policy guidance, market demand, and technological upgrades, more and more insurance companies are actively breaking through, steadily advancing from single-point pilots to large-scale coverage. Ping An Life Insurance North Branch stated that it will continue to deepen the data interconnection of &#34;medical insurance + commercial insurance&#34; to create a one-stop settlement service experience. Currently, direct compensation services have been launched in Beijing at Peking University International Hospital and Peking University Third Hospital, with plans to expand to several well-regarded hospitals such as Xiehe Hospital, Peking University People's Hospital, Peking University First Hospital, Chaoyang Hospital, and Friendship Hospital to comprehensively address various service experience pain points such as cumbersome payments, large upfront costs, and troublesome claims.
Beijing Business Reporter Li Xiumei

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The 2025 insurance industry claims report shows that the claim approval rate generally exceeds 99%, with some small and medium-sized insurance companies also exceeding 98%. Technological means such as AI and online claims services significantly improve claims efficiency and reduce customer hassle. Industry compensation expenditures are expected to reach 2.44 trillion yuan, a year-on-year increase of 6.2%. Insurance companies continue to optimize claims speed and service quality, driving the industry towards an upgrade of "fast, accurate, and warm."

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Insurance Company Claims Report Overview: Claim Approval Rates Generally Reach 99%, Accelerating Exploration of Direct Compensation in Commercial Insurance